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General NPI Number Information
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NPI Number | 1356744056
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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 | 10/08/2014
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 815 W 63RD ST 3RD FLOOR
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City | CHICAGO
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State | IL
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Zip | 60621-1917
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Country | US
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Telephone | 773-873-3400
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Fax | 773-873-9808
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Provider Business Mailing Address
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Address Line | 1001 E TOUHY AVE STE 50
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City | DES PLAINES
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State | IL
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Zip | 60018-5817
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Country | US
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Telephone | 847-635-4600
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Fax | 847-699-5117
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Authorized Official
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Title or Position | CEO
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Name | MARK STUTRUD
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3000540
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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