MEDICARE: ABRAHAM LINCOLN CENTRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1699062521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABRAHAM LINCOLN CENTRE

Provider Business Mailing Address
First Line	:	3858 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-2089
Country	:	US
Telephone Number	:	773-285-1390
Fax Number	:	773-373-6626

Provider Business Practice Location Address
First Line	:	9020 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3508
Country	:	US
Telephone Number	:	773-285-1390
Fax Number	:	773-373-6612

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. ZIRL S. SMITH
Credential	:
Telephone Number	:	773-285-1390

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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Directions to “ABRAHAM LINCOLN CENTRE ” Practice Location

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