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General NPI Number Information
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NPI Number | 1720784572
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Entity Type | Organization
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Legal Business Name | COMMUNITY COUNSELING CENTERS OF CHICAGO
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Dates
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Enumeration Date | 02/03/2023
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 2542 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647-5216
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Country | US
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Telephone | 773-365-7277
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Fax |
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Provider Business Mailing Address
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Address Line | 2014 W BELLE PLAINE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3002
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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 | REVENUE CYCLE MANAGER
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Name | KELLY DAVIS
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Credential |
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Telephone | 872-235-0258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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