Proviso-Leyden Council For Community Action INC
Clinic/Center, Methadone Clinic in Maywood, IL. Organization (NPI-2).
NPI number1386589034
StatusActive
Last updated in NPPESApr 21, 2026
Details
- NPI
- 1386589034
- Entity type
- Organization (NPI-2)
- Legal business name
- Proviso-Leyden Council For Community Action INC
- Organization subpart
- No
- Enumeration date
- Apr 21, 2026
- Certification date
- Apr 20, 2026
- Last updated
- Apr 21, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM2800X | Clinic/Center, Methadone Clinic | – | – | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | |
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – |
Practice location
308 S 5th AveMaywood, IL 60153-1650
Phone 708-343-1275
Mailing address
411 Madison StMaywood, IL 60153-2136
Phone 708-450-3500
Authorized official
Claudette Harrell
Ceo
7084503500
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