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General NPI Number Information
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NPI Number | 1124320577
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Entity Type | Organization
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Legal Business Name | LILAC TREATMENT CENTERS LLC
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 5318-24 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3618
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Country | US
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Telephone | 773-236-8496
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Fax | 773-236-8497
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Provider Business Mailing Address
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Address Line | 5318-24 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3618
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Country | US
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Telephone | 773-236-8496
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Fax | 773-236-8497
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Authorized Official
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Title or Position | PRESIDENT
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Name | BILL GIKOPOULOS
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Credential |
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Telephone | 847-530-6266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | IL
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