Provider Demographics
NPI:1366925489
Name:LURIE CHILDREN'S ADOLESCENT SUBSTANCE ABUSE AND PREVENTION PROGARM
Entity type:Organization
Organization Name:LURIE CHILDREN'S ADOLESCENT SUBSTANCE ABUSE AND PREVENTION PROGARM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-227-1520
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4000
Mailing Address - Fax:
Practice Address - Street 1:1440 N DAYTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2644
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-13
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder