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General NPI Number Information
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NPI Number | 1073724563
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Entity Type | Organization
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Legal Business Name | LUTHERAN SOCIAL SERVICES OF ILLINOIS
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4152 N KEYSTONE AVE
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City | CHICAGO
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State | IL
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Zip | 60641-2436
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Country | US
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Telephone | 773-283-9071
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Fax | 773-283-9185
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Provider Business Mailing Address
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Address Line | 1001 E TOUHY AVE SUITE# 170
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City | DES PLAINES
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State | IL
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Zip | 60018-5801
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Country | US
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Telephone | 847-635-4600
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Fax | 847-297-3407
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. GERALD NOONAN
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Credential |
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Telephone | 847-635-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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