Provider Demographics
NPI:1902228406
Name:CHICAGO TREATMENT AND COUNSELING CENTERS,INC
Entity Type:Organization
Organization Name:CHICAGO TREATMENT AND COUNSELING CENTERS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMLATA
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAIDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-523-3400
Mailing Address - Street 1:9350 CASCADE CIR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3520 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1317
Practice Address - Country:US
Practice Address - Phone:312-399-5282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069638261QM2800X
261QM2800X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone