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General NPI Number Information
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NPI Number | 1104640531
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Entity Type | Organization
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Legal Business Name | LAWRENCE HALL
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1818 E 71ST ST
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City | CHICAGO
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State | IL
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Zip | 60649-2010
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Country | US
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Telephone | 773-360-5113
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Fax |
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Provider Business Mailing Address
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Address Line | 4833 N FRANCISCO AVE
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City | CHICAGO
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State | IL
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Zip | 60625-3640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DEVAN HUGHES
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Credential |
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Telephone | 773-334-7048
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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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