Organization
MARYVILLE ACADEMY
Active
Other names
Family Behavioral Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK SMITH (ADMINISTRATOR OF COMMUNITY SERVICES)
(847) 390-3004
Entity
Organization
Contact information
Practice address
1658 W GRAND AVE, CHICAGO, IL 60622-6309
(312) 491-3530
Mailing address
1658 W GRAND AVE, CHICAGO, IL 60622-6309
(312) 491-3530
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/27/2017
Last updated
06/11/2025
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