Organization
THE SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE
Active
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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