Provider Demographics
NPI:1134258916
Name:OAK PARK RIVER FOREST INFANT WELFARE SOCIETY
Entity type:Organization
Organization Name:OAK PARK RIVER FOREST INFANT WELFARE SOCIETY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:LIPPITT
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:708-848-0528
Mailing Address - Street 1:320 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2612
Mailing Address - Country:US
Mailing Address - Phone:708-848-0528
Mailing Address - Fax:708-848-5855
Practice Address - Street 1:320 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2612
Practice Address - Country:US
Practice Address - Phone:708-848-0528
Practice Address - Fax:708-848-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101348Medicaid
IL=========6030201Medicaid