Organization
PRIDE ROC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN DURCHSLAG (LEAD CLINICIAN)
(312) 860-9552
Entity
Organization
Contact information
Practice address
765 W 69TH ST, CHICAGO, IL 60621-2435
(312) 860-9552
Mailing address
PO BOX 15232, CHICAGO, IL 60615-5141
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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