MEDICARE: THE SALVATION ARMY FAMILY AND COMMUNITY SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1255616025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SALVATION ARMY FAMILY AND COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	4800 N MARINE DR
Second Line	:	1ST FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60640-7859
Country	:	US
Telephone Number	:	773-433-5741
Fax Number	:	773-275-6288

Provider Business Practice Location Address
First Line	:	1616 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3981
Country	:	US
Telephone Number	:	847-392-0265
Fax Number	:	847-392-0274

Authorized Official
Title or Position	:	SUPERVISOR OF CLINICAL SERVICES
Name	:	MR. MARK EMMET RUND
Credential	:	LCSW
Telephone Number	:	773-382-4615

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	10/12/2011

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