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General NPI Number Information
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NPI Number | 1649486887
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Entity Type | Organization
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Legal Business Name | HARBOR LIGHT CENTER, SALVATION ARMY
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 825 N CHRISTIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60651-4110
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Country | US
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Telephone | 312-667-2253
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Fax | 312-421-0823
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Provider Business Mailing Address
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Address Line | 825 N CHRISTIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60651-4110
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Country | US
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Telephone | 312-667-2253
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Fax | 312-421-0823
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MERRILL D POWERS
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Credential | SALVATION ARMY
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Telephone | 312-667-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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