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General NPI Number Information
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NPI Number | 1932414000
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTER OF LAKE VIEW - SUBSTANCE ABUSE
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 3225 N SHEFFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60657-2210
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Country | US
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Telephone | 773-549-5886
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Fax | 773-549-3265
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Provider Business Mailing Address
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Address Line | 3225 N SHEFFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60657-2210
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Country | US
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Telephone | 773-549-5886
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Fax | 773-549-3265
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Authorized Official
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Title or Position | CONTROLLER
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Name | MR. GEORGE JAMES CURTISS
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Credential |
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Telephone | 773-549-1102
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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 | A0127-0001-A
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License Number State | IL
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