Provider Demographics
NPI:1659840221
Name:LUTHERAN SOCIAL SERVICES OF ILLINOIS
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREERANN
Authorized Official - Middle Name:LOVETTE
Authorized Official - Last Name:HAMBLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-390-4422
Mailing Address - Street 1:1001 E TOUHY AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5800
Mailing Address - Country:US
Mailing Address - Phone:847-390-4422
Mailing Address - Fax:847-297-3314
Practice Address - Street 1:1121 N ORLEANS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2511
Practice Address - Country:US
Practice Address - Phone:224-275-1978
Practice Address - Fax:847-297-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-0286-0030-AMedicaid