MEDICARE: LUTHERAN SOCIAL SERVICES OF ILLINOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	3000426	IL

General Provider Information

NPI Number	:	1013310705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN SOCIAL SERVICES OF ILLINOIS

Provider Business Mailing Address
First Line	:	1001 E TOUHY AVE
Second Line	:	SUITE 300
City	:	DES PLAINES
State	:	IL
Zip	:	60018-5801
Country	:	US
Telephone Number	:	847-635-4600
Fax Number	:	847-699-5117

Provider Business Practice Location Address
First Line	:	1111 S ALPINE RD
Second Line	:	SUITE 201
City	:	ROCKFORD
State	:	IL
Zip	:	61108-3940
Country	:	US
Telephone Number	:	815-387-9170
Fax Number	:	815-387-9171

Authorized Official
Title or Position	:	CEO
Name	:	MARK STUTRUD
Credential	:
Telephone Number	:	847-635-4600

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	10/16/2015

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