Provider Demographics
NPI:1912264540
Name:SALVATION ARMY FAMILY AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:SALVATION ARMY FAMILY AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-433-5745
Mailing Address - Street 1:4800 N MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7859
Mailing Address - Country:US
Mailing Address - Phone:773-433-5736
Mailing Address - Fax:773-275-6288
Practice Address - Street 1:5045 W 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2038
Practice Address - Country:US
Practice Address - Phone:773-735-6773
Practice Address - Fax:773-735-6713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-001561251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health