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	314000000X	Skilled Nursing Facility	0013986	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417938838
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	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-5817
Country	:	US
Telephone Number	:	847-635-4600
Fax Number	:	847-390-1426

Provider Business Practice Location Address
First Line	:	1601 NORTH WESTERN AVENUE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1299
Country	:	US
Telephone Number	:	847-825-5531
Fax Number	:	847-318-6659

Authorized Official
Title or Position	:	VP FINANCE CFO
Name	:	MR. GERALD EDMUND NOONAN
Credential	:
Telephone Number	:	847-635-4600

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	08/22/2020

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Directions to “LUTHERAN SOCIAL SERVICES OF ILLINOIS ” Practice Location

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