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NPI Code Detail

MEDICARE: CHICAGO TREATMENT & COUNSELING CENTER #1

MEDICARE: CHICAGO TREATMENT & COUNSELING CENTER #1
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency036069638IL
2261QM2800XMethadone Clinic
3276400000XSubstance Use Disorder Rehabilitation Hospital Unit
4261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1851827067
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO TREATMENT & COUNSELING CENTER #1
Provider Business Mailing Address
First Line : 3520 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3520 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1317
Country : US
Telephone Number : 773-523-3400
Fax Number : 773-523-2193
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : HEMLATA VAIDYA
Credential :
Telephone Number : 773-523-3400
Provider Enumeration Date : 05/08/2017
Last Update Date : 02/25/2022

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