| Columbus Manor | |
|
5107 W Jackson Blvd Chicago IL 60644-4316 | |
| (708) 862-4054 | |
| (708) 862-4138 |
| Full Name | Columbus Manor |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 5107 W Jackson Blvd, Chicago, Illinois |
| Authorized Official Name and Position | James Edward Beckett (MEDICAL DIRECTOR/PRESIDENT) |
| Authorized Official Contact | 7083416707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbus Manor 1609 Sibley Blvd Calumet City IL 60409-2217 Ph: (708) 862-4054 | Columbus Manor 5107 W Jackson Blvd Chicago IL 60644-4316 Ph: (708) 862-4054 |
| NPI Number | 1336608439 |
|---|---|
| Provider Enumeration Date | 03/18/2019 |
| Last Update Date | 03/18/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336608439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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