Healthcare Provider Details

I. General information

NPI: 1356744056
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W 63RD ST 3RD FLOOR
CHICAGO IL
60621-1917
US

IV. Provider business mailing address

1001 E TOUHY AVE STE 50
DES PLAINES IL
60018-5817
US

V. Phone/Fax

Practice location:
  • Phone: 773-873-3400
  • Fax: 773-873-9808
Mailing address:
  • Phone: 847-635-4600
  • Fax: 847-699-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000540
License Number StateIL

VIII. Authorized Official

Name: MARK STUTRUD
Title or Position: CEO
Credential:
Phone: 847-635-4600