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General NPI Number Information
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NPI Number | 1487904660
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Entity Type | Organization
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Legal Business Name | PLCCA, INC.
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 411 W. MADISON ST.
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City | MAYWOOD
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State | IL
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Zip | 60153
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Country | US
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Telephone | 708-450-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 411 W. MADISON ST.
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City | MAYWOOD
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State | IL
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Zip | 60153
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL AND SOCIAL SER
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Name | MRS. EVELYN COKER
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Credential | LCSW
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Telephone | 708-450-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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