The South Suburban Council on Alcoholism and Substance Abuse

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

A-0621-0002-A Issued in IL

Legal business name

THE SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE

Practice address

1909 Cheker SQ
East Hazel Crest, IL 60429-1442

Phone

(708) 647-3333

Fax

(708) 647-3399

NPI assigned

Dec 9, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Allen Sandusky, MA, MBA

Title

President & Ceo

Phone

(708) 647-3300

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

The South Suburban Council on Alcoholism and Substance Abuse5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• South Suburban Council on Alcoholism and Substance Abuse

  • Substance Abuse Rehabilitation Facility
  • East Hazel Crest, IL
  • NPI 1558362863
  NPD tax ID
• The South Suburban Council on Alcoholism and Substance Abuse

  • Substance Abuse Rehabilitation Facility
  • East Hazel Crest, IL
  • NPI 1598234874
  NPD tax ID
• The South Suburban Council on Alcoholism and Substance Abuse

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Hazel Crest, IL
  • NPI 1710049820
  NPD tax ID
• The South Suburban Council on Alcoholism and Substance Abuse

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • East Hazel Crest, IL
  • NPI 1821571274
  NPD tax ID

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449619200000",
    "number": "1568837078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 CHEKER SQ",
            "city": "EAST HAZEL CREST",
            "state": "IL",
            "postal_code": "604291442",
            "telephone_number": "708-647-3333",
            "fax_number": "708-647-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 CHEKER SQ",
            "city": "EAST HAZEL CREST",
            "state": "IL",
            "postal_code": "604291442",
            "telephone_number": "708-647-3333",
            "fax_number": "708-647-3399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-09",
        "last_updated": "2015-12-09",
        "status": "A",
        "authorized_official_last_name": "SANDUSKY",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "708-647-3300",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, MBA"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IL",
            "license": "A-0621-0002-A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710049820",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Suburban Council on Alcoholism and Substance Abuse
• Bradley Matthew Stein
• Althea Jean A. Stockton
• Sharon Stucky
• Margaret Taylor
• The South Suburban Council on Alcoholism and Substance Abuse
• The South Suburban Council on Alcoholism and Substance Abuse
• Sylvia P Thomas, CADC, MISA II
• Venice Thompson
• Total Medical Services, Inc.

• Substance Abuse Rehabilitation Facility in East Hazel Crest, IL
• Providers in East Hazel Crest, IL by specialty
• Substance Abuse Rehabilitation Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; 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.