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General NPI Number Information
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NPI Number | 1558362863
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Entity Type | Organization
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Legal Business Name | SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1909 CHEKER SQ
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City | EAST HAZEL CREST
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State | IL
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Zip | 60429-1442
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Country | US
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Telephone | 708-647-3333
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Fax | 708-957-2614
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Provider Business Mailing Address
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Address Line | 1909 CHEKER SQ
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City | EAST HAZEL CREST
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State | IL
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Zip | 60429-1442
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Country | US
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Telephone | 708-647-3333
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Fax | 708-957-2614
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | MR. ALLEN JOSEPH SANDUSKY
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Credential | MA MBA
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Telephone | 708-647-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-0621-0001-A
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License Number State | IL
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