| B.o.o.c. Inc. | |
|
15475 S Park Ave Ste 101 South Holland IL 60473-1378 | |
| (312) 818-8120 | |
| Not Available |
| Full Name | B.o.o.c. Inc. |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 15475 S Park Ave Ste 101, South Holland, Illinois |
| Authorized Official Name and Position | Lance L Davis (PRESIDENT - CEO) |
| Authorized Official Contact | 7088493237 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| B.o.o.c. Inc. 15475 S Park Ave Ste 101 South Holland IL 60473-1378 Ph: (312) 818-8120 | B.o.o.c. Inc. 15475 S Park Ave Ste 101 South Holland IL 60473-1378 Ph: (312) 818-8120 |
| NPI Number | 1881422293 |
|---|---|
| Provider Enumeration Date | 07/25/2024 |
| Last Update Date | 07/25/2024 |
| Certification Date | 07/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881422293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP1600X | Counselor - Pastoral | (* (Not Available)) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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