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Lutheran Social Services of Illinois

Organization Active NPI Child & Adolescent Psychiatry Physician · Chicago, IL

NPI 1265676597 · NPPES record last updated Apr 30, 2009

Key facts

NPI
1265676597
Entity type
Organization (NPI type 2)
Primary specialty
Child & Adolescent Psychiatry Physician 2084P0804X
Legal business name
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Practice address
4840 W Byron St
Chicago, IL 60641-2712
Phone
(773) 282-7800
Fax
(773) 282-2163
NPI assigned
Apr 30, 2009
Organization subpart
No

Authorized official

Name
Mr. Gerald Noonan
Title
Chief Financial Officer
Phone
(847) 635-4600

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Lutheran Social Services of Illinois (65 organizations share this tax ID)

Locations

4840 W Byron St
Chicago, IL 60641
Phone (773) 282-7800

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0800X
Child & Adolescent Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0804X Yes

Addresses

Primary practice location

4840 W Byron St
Chicago, IL 60641-2712

Mailing address

1001 E Touhy Ave
Suite# 170
Des Plaines, IL 60018-5801
Phone (847) 635-4600

Other identifiers

IdentifierTypeStateIssuer
036095776MedicaidIL
036111400MedicaidIL
036092099MedicaidIL
036113899MedicaidIL
036094832MedicaidIL
036091774MedicaidIL
036105330MedicaidIL

Other names

  • Behavioral Health Services Doing business as

Other providers in Chicago, IL

All providers in Chicago, IL · Child & Adolescent Psychiatry Physician in Illinois

Sources for this page

Verify at the official NPI Registry.