Provider Demographics
NPI:1487824702
Name:JOSHUA ARMS OF LUTHERAN SOCIAL SERVICES OF ILLINOIS
Entity Type:Organization
Organization Name:JOSHUA ARMS OF LUTHERAN SOCIAL SERVICES OF ILLINOIS
Other - Org Name:JOSHUA ARMS OF LUTHERAN SOCIAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROPERTY MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VAYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NATHANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-390-1411
Mailing Address - Street 1:1001 E TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5801
Mailing Address - Country:US
Mailing Address - Phone:847-390-1411
Mailing Address - Fax:847-390-1426
Practice Address - Street 1:1315 ROWELL AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-2849
Practice Address - Country:US
Practice Address - Phone:815-727-6401
Practice Address - Fax:815-727-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid