MEDICARE: ELITE TREATMENT CENTER

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM2800X	Methadone Clinic	A78460001A	IL
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912457219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE TREATMENT CENTER

Provider Business Mailing Address
First Line	:	PO BOX 2122
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60412-8922
Country	:	US
Telephone Number	:	708-755-5117
Fax Number	:	708-755-5404

Provider Business Practice Location Address
First Line	:	395 W LINCOLN HWY
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-2442
Country	:	US
Telephone Number	:	708-755-5117
Fax Number	:	708-755-5404

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	ALBERT ELLIS
Credential	:
Telephone Number	:	708-755-5117

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	04/26/2022

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Directions to “ELITE TREATMENT CENTER ” Practice Location

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