Provider Demographics
NPI:1588623466
Name:LAWRENCE HALL YOUTH SERVICES
Entity Type:Organization
Organization Name:LAWRENCE HALL YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:NUFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-728-2807
Mailing Address - Street 1:2737 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3927
Mailing Address - Country:US
Mailing Address - Phone:773-728-2807
Mailing Address - Fax:773-728-0751
Practice Address - Street 1:4833 N FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3640
Practice Address - Country:US
Practice Address - Phone:773-769-3500
Practice Address - Fax:773-769-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL012231-09, 012232-19251B00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251B00000XAgenciesCase Management