Provider Demographics
NPI:1508108044
Name:CHICAGO ADDICTION SERVICES
Entity Type:Organization
Organization Name:CHICAGO ADDICTION SERVICES
Other - Org Name:AMBROSIA COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CBDO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:561-306-1447
Mailing Address - Street 1:2626 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-3846
Mailing Address - Country:US
Mailing Address - Phone:561-721-8800
Mailing Address - Fax:
Practice Address - Street 1:8601 W BRYN MAWR AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3570
Practice Address - Country:US
Practice Address - Phone:561-721-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health