Provider Demographics
NPI:1841402716
Name:ELISABETH LUDEMAN CENTER
Entity Type:Organization
Organization Name:ELISABETH LUDEMAN CENTER
Other - Org Name:HOUSE 40
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJANI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-283-3011
Mailing Address - Street 1:114 N ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1200
Mailing Address - Country:US
Mailing Address - Phone:708-283-3000
Mailing Address - Fax:708-283-3020
Practice Address - Street 1:114 N ORCHARD DR
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1200
Practice Address - Country:US
Practice Address - Phone:708-283-3000
Practice Address - Fax:708-283-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000950340001Medicaid