Provider Demographics
NPI:1790076628
Name:LAYNIE FOUNDATION
Entity Type:Organization
Organization Name:LAYNIE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-929-6860
Mailing Address - Street 1:4749 LINCOLN MALL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2348
Mailing Address - Country:US
Mailing Address - Phone:312-929-6860
Mailing Address - Fax:219-558-0271
Practice Address - Street 1:4749 LINCOLN MALL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2348
Practice Address - Country:US
Practice Address - Phone:312-929-6860
Practice Address - Fax:219-558-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health