Provider Demographics
NPI:1285496497
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:MRS
Authorized Official - First Name:GREERANN
Authorized Official - Middle Name:LOVETTE
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-390-1422
Mailing Address - Street 1:1001 E TOUHY AVE STE 50
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5817
Mailing Address - Country:US
Mailing Address - Phone:847-390-1422
Mailing Address - Fax:847-297-3407
Practice Address - Street 1:612 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-1541
Practice Address - Country:US
Practice Address - Phone:217-323-5367
Practice Address - Fax:217-323-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04092Medicaid