NPIMap

Organization Active NPI

Proviso-Leyden Council for Community Action Inc

Doing business as Plcca

  • Adult Mental Health Clinic/Center
  • Maywood, IL
National Provider Identifier
1306653613
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC
Doing business as
Plcca
Practice address
411 Madison St
Maywood, IL 60153-2136
Phone
(708) 450-3500
Fax
(708) 236-5184
NPI assigned
Dec 11, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Authorized official

Name
Jacob Aloor Mathew
Title
Board Member
Phone
(708) 632-5610

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X

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 names 1

  • PLCCA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251104002986 IL Part B Supplier - Clinic/Group Practice 3870823024 Receives reassigned benefits from 3 practitioners
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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1733875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776729600000",
    "number": "1306653613",
    "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",
            "fax_number": "708-236-5184"
        },
        {
            "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": "708-450-3500",
            "fax_number": "708-236-5184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-11",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A",
        "authorized_official_last_name": "MATHEW",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "ALOOR",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "708-632-5610"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "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 21, 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.