| Proviso-leyden Council For Community Action Inc | |
|
411 Madison St Maywood IL 60153-2136 | |
| (708) 450-3500 | |
| (708) 236-5184 |
| Full Name | Proviso-leyden Council For Community Action Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 411 Madison St, Maywood, Illinois |
| Authorized Official Name and Position | Rita Jean Mcconville (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7082365164 |
| 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 St Maywood IL 60153-2136 Ph: (708) 450-3500 | Proviso-leyden Council For Community Action Inc 411 Madison St Maywood IL 60153-2136 Ph: (708) 450-3500 |
| NPI Number | 1306653613 |
|---|---|
| Provider Enumeration Date | 12/11/2024 |
| Last Update Date | 01/17/2025 |
| Certification Date | 01/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306653613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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