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NPI Code Detail

MEDICARE: ELISABETH LUDEMAN CENTER

MEDICARE: ELISABETH LUDEMAN CENTER
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number : 1992841480
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELISABETH LUDEMAN CENTER
Provider Business Mailing Address
First Line : 114 N ORCHARD DR
Second Line :
City : PARK FOREST
State : IL
Zip : 60466-1200
Country : US
Telephone Number : 708-283-3018
Fax Number : 708-283-3020
Provider Business Practice Location Address
First Line : 114 N ORCHARD DR
Second Line :
City : PARK FOREST
State : IL
Zip : 60466-1200
Country : US
Telephone Number : 708-283-3018
Fax Number : 708-283-3020
Authorized Official
Title or Position : HEALTH INFORMATION MANAGER
Name : MS. JACQUELYN AMELSE
Credential : HIM
Telephone Number : 708-283-3018
Provider Enumeration Date : 01/30/2007
Last Update Date : 08/22/2020

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1841320702 — 0014 ELISABETH LUDEMAN CENTER
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Practice Fax: 708-283-3020

Directions to “ELISABETH LUDEMAN CENTER ” Practice Location

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