Provider Demographics
NPI:1194104661
Name:LUTHERAN SOCIAL SERVICES OF ILLINOIS
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF ILLINOIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREERANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-390-1422
Mailing Address - Street 1:1001 E TOUHY AVE
Mailing Address - Street 2:STE 170
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 KISHWAUKEE ST
Practice Address - Street 2:STE 101
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2041
Practice Address - Country:US
Practice Address - Phone:815-964-8637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty