Provider Demographics
NPI:1386001311
Name:LUTHERAN SOCIAL SERVICES OF ILLINOIS
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF ILLINOIS
Other - Org Name:LSSI ACA ADD ELGIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GREERANN
Authorized Official - Middle Name:LOVETTE
Authorized Official - Last Name:HAMBLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-390-1422
Mailing Address - Street 1:1001 E TOUHY AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5801
Mailing Address - Country:US
Mailing Address - Phone:847-635-4600
Mailing Address - Fax:847-297-3407
Practice Address - Street 1:675 VARSITY DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-8176
Practice Address - Country:US
Practice Address - Phone:847-741-2600
Practice Address - Fax:847-741-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA02860014-A261QR0405X
ILA02860015-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000593OtherBC/BS
0000000593OtherBC/BS