Provider Demographics
NPI:1710156195
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 1:152 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5652
Practice Address - Country:US
Practice Address - Phone:847-608-2069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00465172033048322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00465172033048OtherDCFS CONTRACT