Alcoholic Rehabilitation Community Home

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

A06870001A Issued in IL

Legal business name

ALCOHOLIC REHABILITATION COMMUNITY HOME

Practice address

1313 21St St
Granite City, IL 62040-4756

Phone

(618) 877-4987

Fax

(618) 877-4930

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Cary Green, CADC

Title

Executive Director

Phone

(618) 877-4987

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891910709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 21ST ST",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404756",
            "telephone_number": "618-877-4987",
            "fax_number": "618-877-4930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 21ST ST",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404756",
            "telephone_number": "618-877-4987",
            "fax_number": "618-877-4930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALCOHOLIC REHABILITATION COMMUNITY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-877-4987",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IL",
            "license": "A06870001A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS - OASA",
            "identifier": "A06870001A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.