Provider Demographics
NPI:1821536236
Name:LE PENSEUR YOUTH & FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:LE PENSEUR YOUTH & FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERRISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-375-8637
Mailing Address - Street 1:8550 S MANISTEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3152
Mailing Address - Country:US
Mailing Address - Phone:773-375-8637
Mailing Address - Fax:773-375-8637
Practice Address - Street 1:1464 W 115TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4465
Practice Address - Country:US
Practice Address - Phone:773-778-4980
Practice Address - Fax:773-778-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA82510003A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC/A82510003AMedicaid