Basic Information
| Provider Information | |||||||||
| NPI: | 1134565690 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUTHERAN SOCIAL SERVICES OF IL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LSSI | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4840 W BYRON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606412712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732827800 | ||||||||
| FaxNumber: | 7732830391 | ||||||||
| Practice Location | |||||||||
| Address1: | 4840 W BYRON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606412712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732827800 | ||||||||
| FaxNumber: | 7732830391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2013 | ||||||||
| LastUpdateDate: | 05/10/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OSEGUERA | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7732827800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | 041359126 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.