Organization
STONYBROOK CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES FRANCIS WALTER (OPERATIONS DIRECTOR)
(630) 221-1400
Entity
Organization
Contact information
Practice address
1506 E ROOSEVELT RD, WHEATON, IL 60187-6806
(630) 221-1400
(630) 221-1411
Mailing address
1506 E ROOSEVELT RD, WHEATON, IL 60187-6806
(630) 221-1400
(630) 221-1411
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A-8645-0001-A
IL
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
A-8645-0002-A
IL
Other
Enumeration date
02/09/2011
Last updated
10/27/2017
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