Provider Demographics
NPI:1992841480
Name:ELISABETH LUDEMAN CENTER
Entity Type:Organization
Organization Name:ELISABETH LUDEMAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH INFORMATION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMELSE
Authorized Official - Suffix:
Authorized Official - Credentials:HIM
Authorized Official - Phone:708-283-3018
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:708-283-3018
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:708-283-3018
Practice Address - Fax:708-283-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities