Organization
OAK BROOK CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM P WEISS (DIRECTOR OF QUALITY MANAGEMENT)
(402) 339-1436
Entity
Organization
Contact information
Practice address
2605 W 22ND ST STE 29, OAK BROOK, IL 60523-4625
(630) 819-8100
(630) 568-3362
Mailing address
2605 W 22ND ST STE 29, OAK BROOK, IL 60523-4625
(630) 819-8100
(630) 568-3362
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-2158-0000-A
STATE OF ILLINOIS, SUPR
IL
Enumeration date
03/19/2020
Last updated
08/05/2021
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