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General NPI Number Information
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NPI Number | 1972752392
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Entity Type | Organization
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Legal Business Name | ELITE HOUSES OF SOBER LIVING,INC.
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 395 W LINCOLN HWY
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-2442
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Country | US
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Telephone | 708-755-5117
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Fax | 708-755-5404
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Provider Business Mailing Address
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Address Line | 395 W LINCOLN HWY PO. BOX 2122
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-2442
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Country | US
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Telephone | 708-755-5117
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Fax | 708-755-5404
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALBERT ELLIS III
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Credential | CADC; NCRS;MISA 1
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Telephone | 312-515-3092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA3000X
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Taxonomy Name | Augmentative Communication Clinic/Center
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License Number | A-4780-0005-A
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | A-4780-0005-A
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-4780-00055-A
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License Number State | IL
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