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General NPI Number Information
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NPI Number | 1760806350
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Entity Type | Organization
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Legal Business Name | LOUDEK COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 10540 S WESTERN AVE STE # 402
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City | CHICAGO
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State | IL
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Zip | 60643-2536
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Country | US
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Telephone | 773-253-7052
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Fax | 773-253-7051
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Provider Business Mailing Address
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Address Line | 10540 S WESTERN AVE STE 402
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City | CHICAGO
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State | IL
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Zip | 60643-2529
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Country | US
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Telephone | 773-253-7052
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Fax | 773-253-7051
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Authorized Official
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Title or Position | CHAIRPERSON
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Name | MR. EMMITT J MARSHALL
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Credential | JURIST DOTORATE
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Telephone | 773-253-7052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2278614
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License Number State | IL
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