NPIMap

Organization Active NPI

The South Suburban Council on Alcoholism and Substance Abuse

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Hazel Crest, IL
National Provider Identifier
1710049820
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
A-0621-0003-A Issued in IL
Legal business name
THE SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE
Practice address
1909 174TH St
Hazel Crest, IL 60429
Phone
(708) 647-3333
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Authorized official

Name
Mr. Myron Graham
Title
Ceo
Phone
(708) 647-3305

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X A-0621-0003-A IL
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X A-0621-0003-A IL Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Substance Abuse Rehabilitation Facility 324500000X A-0621-0004A IL
Substance Abuse Rehabilitation Facility 324500000X A-0621-0002-A IL
Substance Abuse Rehabilitation Facility 324500000X A-0621-0001-A IL

Addresses

Primary practice location

1909 174TH St
Hazel Crest, IL 60429

Mailing address

1909 174TH St
Hazel Crest, IL 60429
Phone (708) 647-3333

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637193600000",
    "number": "1710049820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 174TH ST",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "60429",
            "telephone_number": "708-647-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 174TH ST",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "60429",
            "telephone_number": "708-647-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTH SUBURBAN COUNCIL ON ALCOHOLISM AND SUBSTANCE ABUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2021-11-18",
        "certification_date": "2021-06-10",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "MYRON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-647-3305",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "IL",
            "license": "A-0621-0003-A",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IL",
            "license": "A-0621-0003-A",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IL",
            "license": "A-0621-0004A",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IL",
            "license": "A-0621-0002-A",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IL",
            "license": "A-0621-0001-A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazel Crest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; 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.