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Organization
PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC
Active
Organization
PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC
Active
Other names
PLCCA
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY SMITH (COO)
(708) 236-5170
Entity
Organization
Contact information
Practice address
411 MADISON ST, MAYWOOD, IL 60153-2136
(708) 236-5042
Mailing address
411 MADISON ST, MAYWOOD, IL 60153-2136
(708) 450-3500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215987003
—
IL
Enumeration date
08/28/2013
Last updated
04/17/2026
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