Healthcare Provider Details

I. General information

NPI: 1063943645
Provider Name (Legal Business Name): LF WALLS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 FOX HOUND TRL
BEECHER IL
60401-5106
US

IV. Provider business mailing address

PO BOX 557
MATTESON IL
60443-0557
US

V. Phone/Fax

Practice location:
  • Phone: 708-537-1496
  • Fax: 708-946-3320
Mailing address:
  • Phone: 708-537-1496
  • Fax: 708-946-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA WALLS
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 708-537-1496