Provider Demographics
NPI:1669690038
Name:CHICAGO LIGHTHOUSE
Entity type:Organization
Organization Name:CHICAGO LIGHTHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CHILCREN SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-666-1331
Mailing Address - Street 1:1850 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1228
Mailing Address - Country:US
Mailing Address - Phone:312-666-1331
Mailing Address - Fax:312-506-0103
Practice Address - Street 1:1850 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1228
Practice Address - Country:US
Practice Address - Phone:312-666-1331
Practice Address - Fax:312-506-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty