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General NPI Number Information
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NPI Number | 1740438613
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Entity Type | Organization
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Legal Business Name | ASSOCIATION HOUSE OF CHICAGO
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 1116 N. KEDZIE
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City | CHICAGO
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State | IL
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Zip | 60651
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Country | US
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Telephone | 773-772-7170
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Fax | 773-384-0560
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Provider Business Mailing Address
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Address Line | 1116 N. KEDZIE
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City | CHICAGO
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State | IL
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Zip | 60651
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Country | US
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Telephone | 773-772-7170
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Fax | 773-384-0560
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HARRIET SADAUSKAS
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Credential |
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Telephone | 773-772-7170
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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 | IL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A-0102-0001-A
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License Number State | IL
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