Healthcare Provider Details

I. General information

NPI: 1386001311
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 VARSITY DR
ELGIN IL
60120-8176
US

IV. Provider business mailing address

1001 E TOUHY AVE SUITE 170
DES PLAINES IL
60018-5801
US

V. Phone/Fax

Practice location:
  • Phone: 847-741-2600
  • Fax: 847-741-3248
Mailing address:
  • Phone: 847-635-4600
  • Fax: 847-297-3407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA02860014-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA02860015-A
License Number StateIL

VIII. Authorized Official

Name: MS. GREERANN LOVETTE HAMBLET
Title or Position: BUSINESS MANAGER
Credential:
Phone: 847-390-1422