Provider Demographics
NPI:1134390826
Name:MERCY HOUSING LAKEFRONT
Entity type:Organization
Organization Name:MERCY HOUSING LAKEFRONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P., COMMUNITY SUPPORTIVE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-447-4532
Mailing Address - Street 1:247 S STATE ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-2053
Mailing Address - Country:US
Mailing Address - Phone:312-447-4550
Mailing Address - Fax:312-447-4750
Practice Address - Street 1:1521 S WABASH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2919
Practice Address - Country:US
Practice Address - Phone:312-447-4695
Practice Address - Fax:312-447-4764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management