Organization
THE SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MYRON GRAHAM (CEO)
(708) 647-3305
Entity
Organization
Contact information
Practice address
1909 174TH ST, HAZEL CREST, IL 60429
(708) 647-3333
Mailing address
1909 174TH ST, HAZEL CREST, IL 60429
(708) 647-3333
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
A-0621-0003-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-0621-0003-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
A-0621-0001-A
IL
324500000X
Substance Abuse Rehabilitation Facility
A-0621-0002-A
IL
324500000X
Substance Abuse Rehabilitation Facility
A-0621-0004A
IL
Other
Enumeration date
12/14/2006
Last updated
11/18/2021
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