Provider Demographics
NPI:1245662337
Name:FAMILY SHELTER SERVICE
Entity type:Organization
Organization Name:FAMILY SHELTER SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELING CENTER COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-221-8290
Mailing Address - Street 1:605 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5568
Mailing Address - Country:US
Mailing Address - Phone:630-221-8290
Mailing Address - Fax:630-221-8098
Practice Address - Street 1:605 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5568
Practice Address - Country:US
Practice Address - Phone:630-221-8290
Practice Address - Fax:630-221-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health