Organization
IT'S ABOUT CHANGE SOBER LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY DILLARD SR. NCRS (CEO)
(708) 772-5014
Entity
Organization
Contact information
Practice address
1604 HORBOR ST., CALUMET CITY, IL 60409
(708) 360-3205
(708) 868-8335
Mailing address
394 MADISON AVE, CALUMET CITY, IL 60409-2107
(708) 868-5014
(708) 868-8335
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A-8723-0003-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C/A-8723-0003-A
—
IL
Enumeration date
03/08/2017
Last updated
03/08/2017
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