Provider Demographics
NPI: | 1497030266 |
---|---|
Name: | THE SALVATION FAMILY AND COMMUNITY SERVICES |
Entity Type: | Organization |
Organization Name: | THE SALVATION FAMILY AND COMMUNITY SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SUPERVISOR OF CLINICAL SERVICES |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MARK |
Authorized Official - Middle Name: | EMMET |
Authorized Official - Last Name: | RUND |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 773-382-4615 |
Mailing Address - Street 1: | 4800 N MARINE DR |
Mailing Address - Street 2: | 1ST FLOOR |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60640-7859 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 773-433-5741 |
Mailing Address - Fax: | 773-275-6288 |
Practice Address - Street 1: | 609 W DEMPSTER ST |
Practice Address - Street 2: | |
Practice Address - City: | DES PLAINES |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60016-2651 |
Practice Address - Country: | US |
Practice Address - Phone: | 847-981-9113 |
Practice Address - Fax: | 847-981-9110 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | THE SALVATION ARMY |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2011-10-12 |
Last Update Date: | 2011-10-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |