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General NPI Number Information
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NPI Number | 1992070031
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Entity Type | Organization
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Legal Business Name | LAKAR ENTERPRISE LLC
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 15525 S PARK AVE STE 114
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-1380
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Country | US
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Telephone | 708-263-9512
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Fax | 708-825-1244
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Provider Business Mailing Address
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Address Line | 3343 171ST ST
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City | LANSING
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State | IL
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Zip | 60438-1105
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Country | US
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Telephone | 708-263-9512
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELVINA STEGALL
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Credential | MHS,CADC, DASA
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Telephone | 708-263-9512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A58520002A
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | IL
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