Organization
THE SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN SANDUSKY MA, MBA (PRESIDENT & CEO)
(708) 647-3300
Entity
Organization
Contact information
Practice address
1909 CHEKER SQ, EAST HAZEL CREST, IL 60429-1442
(708) 647-3333
(708) 647-3399
Mailing address
1909 CHEKER SQ, EAST HAZEL CREST, IL 60429-1442
(708) 647-3333
(708) 647-3399
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
A-0621-0002-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710049820
—
IL
Enumeration date
12/09/2015
Last updated
12/09/2015
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