Provider Demographics
NPI:1306653613
Name:PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC
Entity type:Organization
Organization Name:PROVISO-LEYDEN COUNCIL FOR COMMUNITY ACTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MCCONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:708-236-5164
Mailing Address - Street 1:411 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-2136
Mailing Address - Country:US
Mailing Address - Phone:708-450-3500
Mailing Address - Fax:708-236-5184
Practice Address - Street 1:411 MADISON ST
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-2136
Practice Address - Country:US
Practice Address - Phone:708-450-3500
Practice Address - Fax:708-236-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health