Active NPI
It's About Change Sober Living, Inc.
- Community/Behavioral Health Agency
- Calumet City, IL
National Provider Identifier
1801336961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- A-8723-0003-A
- Legal business name
- IT'S ABOUT CHANGE SOBER LIVING, INC.
- Practice address
- 1604 Horbor St.
Calumet City, IL 60409 - Phone
- (708) 360-3205
- Fax
- (708) 868-8335
- NPI assigned
- Mar 8, 2017
- Last updated
- Mar 8, 2017
- 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
- Dr. Anthony Dillard Sr., NCRS
- Title
- Ceo
- Phone
- (708) 772-5014
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | A-8723-0003-A | IL | Primary |
Addresses
Primary practice location
1604 Horbor St.
Calumet City, IL 60409
Mailing address
394 Madison Ave
Calumet City, IL 60409-2107
Phone (708) 868-5014
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C/A-8723-0003-A | Medicaid | IL |
National Provider Directory
National Provider Directory- Tax ID family
- It's About Change Sober Living Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Elgin, IL
- NPI 1790225050
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.
-
- Addiction (Substance Use Disorder) Counselor
- Elgin, IL
- NPI 1003356742
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488931200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1488931200000",
"number": "1801336961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "394 MADISON AVE",
"city": "CALUMET CITY",
"state": "IL",
"postal_code": "604092107",
"telephone_number": "708-868-5014",
"fax_number": "708-868-8335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1604 HORBOR ST.",
"city": "CALUMET CITY",
"state": "IL",
"postal_code": "60409",
"telephone_number": "708-360-3205",
"fax_number": "708-868-8335"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IT'S ABOUT CHANGE SOBER LIVING, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2017-03-08",
"last_updated": "2017-03-08",
"status": "A",
"authorized_official_last_name": "DILLARD",
"authorized_official_first_name": "ANTHONY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "708-772-5014",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Sr.",
"authorized_official_credential": "NCRS"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "IL",
"license": "A-8723-0003-A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "C/A-8723-0003-A",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Calumet City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.