Provider Demographics
NPI:1063943645
Name:LF WALLS CORP
Entity type:Organization
Organization Name:LF WALLS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:708-537-1496
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0557
Mailing Address - Country:US
Mailing Address - Phone:708-537-1496
Mailing Address - Fax:708-946-3320
Practice Address - Street 1:1404 FOX HOUND TRL
Practice Address - Street 2:
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-5106
Practice Address - Country:US
Practice Address - Phone:708-537-1496
Practice Address - Fax:708-946-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services