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General NPI Number Information
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NPI Number | 1134565690
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Entity Type | Organization
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Legal Business Name | LUTHERAN SOCIAL SERVICES OF IL
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 05/10/2013
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Provider Practice Location Address
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Address Line | 4840 W BYRON ST
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City | CHICAGO
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State | IL
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Zip | 60641-2712
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Country | US
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Telephone | 773-282-7800
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Fax | 773-283-0391
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Provider Business Mailing Address
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Address Line | 4840 W BYRON ST
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City | CHICAGO
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State | IL
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Zip | 60641-2712
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Country | US
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Telephone | 773-282-7800
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Fax | 773-283-0391
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CHERYL OSEGUERA
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Credential |
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Telephone | 773-282-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 041359126
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License Number State | IL
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