| Proviso Leyden Council For Community Action, Inc. | |
|
411 Madison W St Maywood IL 60153-2136 | |
| (708) 450-3500 | |
| Not Available |
| Full Name | Proviso Leyden Council For Community Action, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 411 Madison W St, Maywood, Illinois |
| Authorized Official Name and Position | Pamela M Yates (DATA/BILLING SPECIALIST) |
| Authorized Official Contact | 7084503500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proviso Leyden Council For Community Action, Inc. 411 Madison W St Maywood IL 60153-2136 Ph: () - | Proviso Leyden Council For Community Action, Inc. 411 Madison W St Maywood IL 60153-2136 Ph: (708) 450-3500 |
| NPI Number | 1023442753 |
|---|---|
| Provider Enumeration Date | 08/29/2013 |
| Last Update Date | 08/05/2022 |
| Certification Date | 05/24/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023442753 | NPI | - | NPPES |
| 1215987003 | Medicaid | IL |
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Proviso Leyden Council For Community Action Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 411 Madison St, Maywood, IL 60153 Phone: 708-450-3500 Fax: 708-236-5186 |