NPIMap

Organization Active NPI

Ican Community Services Inc. NFP

  • Community/Behavioral Health Agency
  • South Holland, IL
National Provider Identifier
1063702330
Registry record updated Dec 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
A-5212-0001-A Issued in IL
Legal business name
ICAN COMMUNITY SERVICES INC. NFP
Practice address
15475 S Park Ave
Suite 109
South Holland, IL 60473-1328
Phone
(708) 596-5680
NPI assigned
Apr 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anthony Olujimi, M.D, MPHNPI 1114432564
Title
President/Ceo
Phone
(708) 297-8580

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X A-5212-0001-A IL Primary
Methadone Clinic 261QM2800X A-5212-0001-A IL
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X A-5212-0001-A IL

Addresses

Primary practice location

15475 S Park Ave
Suite 109
South Holland, IL 60473-1328

Mailing address

15475 S Park Ave
Suite 109
South Holland, IL 60473-1328
Phone (708) 596-5680

Other identifiers 1

IdentifierTypeStateIssuer
IL-10,172MOtherILFDA NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513900800000",
    "number": "1063702330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15475 S PARK AVE",
            "address_2": "SUITE 109",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731328",
            "telephone_number": "708-596-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15475 S PARK AVE",
            "address_2": "SUITE 109",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731328",
            "telephone_number": "708-596-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICAN COMMUNITY SERVICES INC. NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-07",
        "last_updated": "2017-12-22",
        "status": "A",
        "authorized_official_last_name": "OLUJIMI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "708-297-8580",
        "authorized_official_credential": "M.D, MPH"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "A-5212-0001-A",
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "IL",
            "license": "A-5212-0001-A",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IL",
            "license": "A-5212-0001-A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FDA NUMBER",
            "identifier": "IL-10,172M",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Holland, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.