| Supported Independence | |
|
17009 Elm Drive Hazel Crest IL 60429 | |
| (630) 667-7370 | |
| Not Available |
| Full Name | Supported Independence |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 17009 Elm Drive, Hazel Crest, Illinois |
| Authorized Official Name and Position | Jessica Luckett (PRESIDENT) |
| Authorized Official Contact | 6306677370 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supported Independence 17900 Elm Drive Hazel Crest IL 60429 Ph: (630) 667-7370 | Supported Independence 17009 Elm Drive Hazel Crest IL 60429 Ph: (630) 667-7370 |
| NPI Number | 1649548405 |
|---|---|
| Provider Enumeration Date | 12/08/2011 |
| Last Update Date | 12/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649548405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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