Organization
ICAN COMMUNITY SERVICES INC. NFP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY OLUJIMI M.D, MPH (PRESIDENT/CEO)
(708) 297-8580
Entity
Organization
Contact information
Practice address
15475 S PARK AVE, SUITE 109, SOUTH HOLLAND, IL 60473-1328
(708) 596-5680
Mailing address
15475 S PARK AVE, SUITE 109, SOUTH HOLLAND, IL 60473-1328
(708) 596-5680
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A-5212-0001-A
IL
261QM2800X
Methadone Clinic
A-5212-0001-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
A-5212-0001-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL-10,172M
FDA NUMBER
IL
Enumeration date
04/07/2011
Last updated
12/22/2017
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