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General NPI Number Information
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NPI Number | 1437400421
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Entity Type | Organization
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Legal Business Name | LAWRENCE HALL YOUTH SERVICES
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 6621 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60626-4106
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Country | US
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Telephone | 773-728-2807
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Fax | 773-728-0751
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Provider Business Mailing Address
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Address Line | 2737 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-3927
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Country | US
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Telephone | 773-728-2807
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Fax | 773-728-0751
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MARK NUFER
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Credential |
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Telephone | 773-728-2807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 12057909
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 12057909
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License Number State | IL
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