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Icc Treatment Center — NPI 1164388484, Chicago, IL | NPI Central

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NPI 1164388484

OrganizationActive

Icc Treatment Center

NPI 1164388484 · Methadone Clinic · Chicago, IL

Provider details

NPI number: 1164388484
Entity type: Organization
Primary specialty: Methadone ClinicAmbulatory Health Care Facilities
Organization subpart: No
Authorized official: Marvin Coklow, Compliance Officer(773) 597-7698

Specialties & taxonomies

Methadone ClinicPrimary261QM2800X
Ambulatory Health Care Facilities
Substance Use Disorder Rehabilitation Hospital Unit276400000X
Hospital Units

Practice location

1 E 111th Street

Chicago, IL 60628-9998

Phone: (773) 552-2769

Approximate (ZIP-level) locationGet directions

More IL providers

Mailing address

1 E 111th Street

Chicago, IL 60628-9998

Registry dates

Enumerated: 2025-12-30
Last updated: 2026-04-03
Certified: 2026-04-03

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.