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NPI Code Detail

MEDICARE: 0014 ELISABETH LUDEMAN CENTER

MEDICARE: 0014 ELISABETH LUDEMAN CENTER
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
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment FacilityIL

Other Identifiers

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

General Provider Information

NPI Number : 1841320702
Entity Type Code : Organization
Provider Name (Legal Business Name) : 0014 ELISABETH LUDEMAN CENTER
Provider Business Mailing Address
First Line : 114 N ORCHARD DR
Second Line :
City : PARK FOREST
State : IL
Zip : 60466-1200
Country : US
Telephone Number : 708-283-3000
Fax Number : 708-283-3020
Provider Business Practice Location Address
First Line : 114 N ORCHARD DR
Second Line :
City : PARK FOREST
State : IL
Zip : 60466-1200
Country : US
Telephone Number : 708-283-3000
Fax Number : 708-283-3020
Authorized Official
Title or Position : CENTER DIRECTOR
Name : MR. DAVID I DECKER
Credential :
Telephone Number : 708-283-3001
Provider Enumeration Date : 03/07/2007
Last Update Date : 06/13/2008

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1992841480 — ELISABETH LUDEMAN CENTER
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Directions to “0014 ELISABETH LUDEMAN CENTER ” Practice Location

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