Provider Demographics
NPI:1689100356
Name:CHICAGO TREATMENT & COUNSELING CENTER #2
Entity Type:Organization
Organization Name:CHICAGO TREATMENT & COUNSELING CENTER #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEMLATA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-656-9500
Mailing Address - Street 1:4453 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5659
Mailing Address - Country:US
Mailing Address - Phone:773-506-2900
Mailing Address - Fax:773-506-8987
Practice Address - Street 1:4453 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5659
Practice Address - Country:US
Practice Address - Phone:773-506-2900
Practice Address - Fax:773-506-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360699638251S00000X
261QM2800X, 261QR0405X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit