NPIMap

Organization Active NPI

Lutheran Social Services of Illinois

Doing business as LSSI MADO Healthcare Douglas Park

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Chicago, IL
National Provider Identifier
1154890721
Registry record updated Nov 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Doing business as
LSSI MADO Healthcare Douglas Park
Practice address
1550 S Albany Ave
Chicago, IL 60623-2212
Phone
(224) 275-1978
Fax
(847) 297-3314
NPI assigned
Nov 13, 2018
Last updated
Nov 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Greerann Lovette Hamblet
Title
Business Manager
Phone
(847) 390-4422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

1550 S Albany Ave
Chicago, IL 60623-2212

Mailing address

1001 E Touhy Ave Ste 170
Des Plaines, IL 60018-5800
Phone (847) 390-4422

Other identifiers 1

IdentifierTypeStateIssuer
A-02860029-AMedicaidIL

Other names 1

  • LSSI MADO Healthcare Douglas Park Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lutheran Social Services of Illinois65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542067200000",
    "number": "1154890721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E TOUHY AVE STE 170",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600185800",
            "telephone_number": "847-390-4422",
            "fax_number": "847-297-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 S ALBANY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606232212",
            "telephone_number": "224-275-1978",
            "fax_number": "847-297-3314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN SOCIAL SERVICES OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-13",
        "last_updated": "2018-11-13",
        "status": "A",
        "authorized_official_last_name": "HAMBLET",
        "authorized_official_first_name": "GREERANN",
        "authorized_official_middle_name": "LOVETTE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "847-390-4422"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A-02860029-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LSSI MADO Healthcare Douglas Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.