Organization
PRENTICE PLACE
Active
Organization
PRENTICE PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PRENTICE EARL CADC,NCRS,CAMSLL (EXECUTIVE DIRECTOR)
(773) 391-3123
Entity
Organization
Contact information
Practice address
255 W 112TH PL, CHICAGO, IL 60628-4132
(773) 391-3123
(773) 701-6844
Mailing address
1115 S PLYMOUTH CT APT 501, CHICAGO, IL 60605-2032
(773) 391-3123
(312) 753-3326
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/21/2017
Last updated
11/21/2017
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