Provider Demographics
NPI:1124320577
Name:LILAC TREATMENT CENTERS LLC
Entity type:Organization
Organization Name:LILAC TREATMENT CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIKOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-530-6266
Mailing Address - Street 1:5318-24 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3618
Mailing Address - Country:US
Mailing Address - Phone:773-236-8496
Mailing Address - Fax:773-236-8497
Practice Address - Street 1:5318-24 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3618
Practice Address - Country:US
Practice Address - Phone:773-236-8496
Practice Address - Fax:773-236-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091684Medicaid
IL1679606560OtherNPI - DR. PUSZKARSKI
IL036091684Medicaid
ILL64632Medicare PIN