Provider Demographics
NPI:1760806350
Name:LOUDEK COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:LOUDEK COMMUNITY SERVICES, INC.
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMITT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:JURIST DOTORATE
Authorized Official - Phone:773-253-7052
Mailing Address - Street 1:10540 S WESTERN AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2529
Mailing Address - Country:US
Mailing Address - Phone:773-253-7052
Mailing Address - Fax:773-253-7051
Practice Address - Street 1:10540 S WESTERN AVE
Practice Address - Street 2:STE # 402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2536
Practice Address - Country:US
Practice Address - Phone:773-253-7052
Practice Address - Fax:773-253-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2278614251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL819206Medicaid
IL819206Medicaid