NPIMap

Organization Active NPI

Proviso-Leyden Council for Community Action Inc

  • Methadone Clinic
  • Maywood, IL
National Provider Identifier
1134553076
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC
Practice address
411 Madison St
Maywood, IL 60153-2136
Phone
(708) 236-5042
NPI assigned
Aug 28, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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

Authorized official

Name
Beverly Smith
Title
Coo
Phone
(708) 236-5170

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Methadone Clinic 261QM2800X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Substance Use Disorder Rehabilitation Hospital Unit 276400000X

Addresses

Primary practice location

411 Madison St
Maywood, IL 60153-2136

Mailing address

411 Madison St
Maywood, IL 60153-2136
Phone (708) 450-3500

Other identifiers 1

IdentifierTypeStateIssuer
1215987003MedicaidIL

Other names 1

  • PLCCA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Opioid treatment program
Medicare-enrolled since Feb 28, 2024

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240627003351 IL Part B Supplier - Opioid Treatment Program (Otp) 3870823024 Practice locations: Maywood, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Proviso-Leyden Council9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

308 S 5th Ave
Maywood, IL 60153
Phone (708) 343-1275

NPI Registry JSON

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

{
    "created_epoch": "1377648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776384000000",
    "number": "1134553076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 MADISON ST",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532136",
            "telephone_number": "708-450-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 MADISON ST",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532136",
            "telephone_number": "708-236-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-28",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "708-236-5170"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215987003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLCCA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PLCCA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maywood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.