Basic Information
| Provider Information | |||||||||
| NPI: | 1013310705 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUTHERAN SOCIAL SERVICES OF ILLINOIS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTOUCH HOME CARE SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 E TOUHY AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600185801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476354600 | ||||||||
| FaxNumber: | 8476995117 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 S ALPINE RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611083940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153879170 | ||||||||
| FaxNumber: | 8153879171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2014 | ||||||||
| LastUpdateDate: | 10/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | STUTRUD | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8476354600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | 3000426 | IL | Y | Agencies | In Home Supportive Care |
No ID Information.