Provider Demographics
NPI:1891832507
Name:CROSS OF GLORY LUTHERAN CHURCH
Entity Type:Organization
Organization Name:CROSS OF GLORY LUTHERAN CHURCH
Other - Org Name:WELCOME PLACE CHRISTIAN CARE AND COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:708-301-6247
Mailing Address - Street 1:14719 W 163RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8018
Mailing Address - Country:US
Mailing Address - Phone:708-301-6247
Mailing Address - Fax:708-301-7126
Practice Address - Street 1:14719 W 163RD ST
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8018
Practice Address - Country:US
Practice Address - Phone:708-301-6247
Practice Address - Fax:708-301-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty