| It's About Change Sober Living, Inc. | |
|
1604 Horbor St. Calumet City IL 60409 | |
| (708) 360-3205 | |
| (708) 868-8335 |
| Full Name | It's About Change Sober Living, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1604 Horbor St., Calumet City, Illinois |
| Authorized Official Name and Position | Anthony Dillard (CEO) |
| Authorized Official Contact | 7087725014 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| It's About Change Sober Living, Inc. 394 Madison Ave Calumet City IL 60409-2107 Ph: (708) 868-5014 | It's About Change Sober Living, Inc. 1604 Horbor St. Calumet City IL 60409 Ph: (708) 360-3205 |
| NPI Number | 1801336961 |
|---|---|
| Provider Enumeration Date | 03/08/2017 |
| Last Update Date | 03/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801336961 | NPI | - | NPPES |
| C/A-8723-0003-A | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A-8723-0003-A (Illinois) | Primary |
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