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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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