Provider Demographics
NPI:1174670293
Name:CENTER FOR OUTPATIENT ALCOHOLISM TREATMENT
Entity Type:Organization
Organization Name:CENTER FOR OUTPATIENT ALCOHOLISM TREATMENT
Other - Org Name:D/BA PROJECT C.O.A.T.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-599-1067
Mailing Address - Street 1:8938 S. RIDGELAND AVENUE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-599-1067
Mailing Address - Fax:708-599-1095
Practice Address - Street 1:8938 S. RIDGELAND AVENUE, SUITE 100
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-599-1067
Practice Address - Fax:708-599-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder