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NPI Code Detail

MEDICARE: LUTHERAN SOCIAL SERVICES OF ILLINOIS

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
1324500000XSubstance Abuse Rehabilitation FacilityA-0286-0011-AIL
2324500000XSubstance Abuse Rehabilitation FacilityA-0286-0008-AIL
3324500000XSubstance Abuse Rehabilitation FacilityA-0286-0012-AIL
4261QR0405XSubstance Use Disorder Rehabilitation Clinic/CenterA-0286-0009-AIL

General Provider Information

NPI Number : 1932318920
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUTHERAN SOCIAL SERVICES OF ILLINOIS
Provider Business Mailing Address
First Line : 1001 E TOUHY AVE STE 50
Second Line :
City : DES PLAINES
State : IL
Zip : 60018-5817
Country : US
Telephone Number : 847-635-4600
Fax Number : 847-297-3407
Provider Business Practice Location Address
First Line : 5517 N KENMORE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1515
Country : US
Telephone Number : 773-275-7962
Fax Number : 773-275-0728
Authorized Official
Title or Position : PRESIDENT
Name : MARK STUTRUD
Credential :
Telephone Number : 847-390-4651
Provider Enumeration Date : 05/22/2007
Last Update Date : 08/13/2020

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Directions to “LUTHERAN SOCIAL SERVICES OF ILLINOIS ” Practice Location

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