NPIMap

Organization Active NPI

Proviso Leyden Council for Community Action

  • Community/Behavioral Health Agency
  • Maywood, IL
National Provider Identifier
1962781971
Registry record updated Aug 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION
Practice address
411 Madison St
Maywood, IL 60153-2136
Phone
(708) 450-3500
Fax
(708) 236-5189
NPI assigned
Aug 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2011

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

Authorized official

Name
Mrs. Evelyn Joy Coker, L.C.S.W.
Title
Dir. of Clinical & Social Services
Phone
(708) 450-3500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X IL Primary

Addresses

Primary practice location

411 Madison St
Maywood, IL 60153-2136

Mailing address

411 Madison St
PO Box 950
Maywood, IL 60153-2136
Phone (708) 450-3500

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.

NPI Registry JSON

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

{
    "created_epoch": "1312761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312761600000",
    "number": "1962781971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 MADISON ST",
            "address_2": "PO BOX 950",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532136",
            "telephone_number": "708-450-3500",
            "fax_number": "708-236-5189"
        },
        {
            "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": "708-236-5189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-08",
        "last_updated": "2011-08-08",
        "status": "A",
        "authorized_official_last_name": "COKER",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "DIR. OF CLINICAL & SOCIAL SERVICES",
        "authorized_official_telephone_number": "708-450-3500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 8, 2011; 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.