Organization
ICC TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARVIN D COKLOW (COMPLIANCE OFFICER)
(773) 597-7698
Entity
Organization
Contact information
Practice address
1 E 111TH STREET, CHICAGO, IL 60628-9998
(773) 552-2769
Mailing address
1 E 111TH STREET, CHICAGO, IL 60628-9998
(773) 552-2769
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
Other
Enumeration date
12/30/2025
Last updated
04/03/2026
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