MEDICARE: ILG SERVICES LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1083284772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILG SERVICES LLC

Provider Business Mailing Address
First Line	:	9466 GEORGIA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1456
Country	:	US
Telephone Number	:	202-751-8579
Fax Number	:

Provider Business Practice Location Address
First Line	:	2839 31ST PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-1603
Country	:	US
Telephone Number	:	202-751-8579
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. IVY GILMORE
Credential	:	LCSW-C
Telephone Number	:	202-751-8579

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	06/25/2021

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Directions to “ILG SERVICES LLC ” Practice Location

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