Active NPI
Icc Treatment Center
- Methadone Clinic
- Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Methadone Clinic
- Legal business name
- ICC TREATMENT CENTER
- Practice address
- 1 E 111TH Street
Chicago, IL 60628-9998 - Phone
- (773) 552-2769
- NPI assigned
- Dec 30, 2025
- Last updated
- Apr 3, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Marvin D Coklow
- Title
- Compliance Officer
- Phone
- (773) 597-7698
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | Primary | ||
| Substance Use Disorder Rehabilitation Hospital Unit | 276400000X |
Addresses
Primary practice location
1 E 111TH Street
Chicago, IL 60628-9998
Mailing address
1 E 111TH Street
Chicago, IL 60628-9998
Phone (773) 552-2769
National Provider Directory
National Provider Directory- Tax ID family
- Icc Treatment Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Adult Mental Health Clinic/Center
- Chicago, IL
- NPI 1699631929
Locations
1 E 111th St
Chicago, IL 60628
Phone (773) 552-2769
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Point of Service
- Chicago, IL
- NPI 1710612478
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1767052800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1775174400000",
"number": "1164388484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 E 111TH STREET",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606289998",
"telephone_number": "773-552-2769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 E 111TH STREET",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606289998",
"telephone_number": "773-552-2769"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ICC TREATMENT CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2025-12-30",
"last_updated": "2026-04-03",
"certification_date": "2026-04-03",
"status": "A",
"authorized_official_last_name": "COKLOW",
"authorized_official_first_name": "MARVIN",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "COMPLIANCE OFFICER",
"authorized_official_telephone_number": "773-597-7698",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QM2800X",
"taxonomy_group": "",
"desc": "Clinic/Center, Methadone",
"state": null,
"license": null,
"primary": true
},
{
"code": "276400000X",
"taxonomy_group": "",
"desc": "Rehabilitation, Substance Use Disorder Unit",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.