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General NPI Number Information
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NPI Number | 1821536236
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Entity Type | Organization
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Legal Business Name | LE PENSEUR YOUTH & FAMILY SERVICES, INC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 1464 W 115TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-4465
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Country | US
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Telephone | 773-778-4980
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Fax | 773-778-4988
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Provider Business Mailing Address
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Address Line | 8550 S MANISTEE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-3152
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Country | US
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Telephone | 773-375-8637
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Fax | 773-375-8637
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. REGINALD SUMMERRISE
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Credential |
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Telephone | 773-375-8637
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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 | A82510003A
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License Number State | IL
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