Provider Demographics
NPI:1922331958
Name:LAWRENCE HALL YOUTH SERVICES
Entity Type:Organization
Organization Name:LAWRENCE HALL YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:NUFER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:773-728-2807
Mailing Address - Street 1:65 E WACKER PL
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7296
Mailing Address - Country:US
Mailing Address - Phone:312-346-3383
Mailing Address - Fax:312-346-6547
Practice Address - Street 1:65 E WACKER PL
Practice Address - Street 2:7TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7296
Practice Address - Country:US
Practice Address - Phone:312-346-3383
Practice Address - Fax:312-346-6547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL012231-10251B00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========016OtherILLINOIS DEPARTMENT OF HEALTHCARE & FAMILY SERVICES