MEDICARE: PARK LAWN SCHOOL & ACTIVITY CENTER, INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency	NONE	IL
2	315P00000X	Intellectual Disabilities Intermediate Care Facility	0027078	IL
3	315P00000X	Intellectual Disabilities Intermediate Care Facility	0035527	IL
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	92C173	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	92C172	OTHER	IL	DHS LICENSE

General Provider Information

NPI Number	:	1609094788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK LAWN SCHOOL & ACTIVITY CENTER, INC.

Provider Business Mailing Address
First Line	:	10833 LAPORTE AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-5412
Country	:	US
Telephone Number	:	708-425-3344
Fax Number	:	708-425-3530

Provider Business Practice Location Address
First Line	:	10833 LAPORTE AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-5412
Country	:	US
Telephone Number	:	708-425-3344
Fax Number	:	708-425-3530

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES R WEISE
Credential	:
Telephone Number	:	708-425-3344

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	09/11/2025

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