Basic Information
| Provider Information | |||||||||
| NPI: | 1760435176 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUTHERAN SOCIAL SERVICES OF ILLINOIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 E. TOUHY AVENUE | ||||||||
| Address2: | SUITE# 50 | ||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600185801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476354600 | ||||||||
| FaxNumber: | 8476356764 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 E TOUHY AVENUE | ||||||||
| Address2: | SUITE 50 | ||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473901465 | ||||||||
| FaxNumber: | 8472973407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | STUTRUD | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8473901461 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | 013005 | IL | Y | Agencies | Voluntary or Charitable |
No ID Information.