Provider Demographics
NPI:1558531947
Name:THE LARKIN CENTER
Entity Type:Organization
Organization Name:THE LARKIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:847-695-5656
Mailing Address - Street 1:1212 LARKIN AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6042
Mailing Address - Country:US
Mailing Address - Phone:847-695-5656
Mailing Address - Fax:847-695-0897
Practice Address - Street 1:474 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3829
Practice Address - Country:US
Practice Address - Phone:847-608-2682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TC0700X, 1041C0700X
IL38443402033068251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL38443402033068OtherDCFS CONTRACT
IL00465172033048OtherDCFS CONTRACT
IL00954672033048OtherDCFS CONTRACT
IL24728372033048OtherDCFS CONTRACT
IL01578872033048OtherDCFS CONTRACT
IL02116072013018OtherDCFS CONTRACT
IL21335772033048OtherDCFS CONTRACT