Provider Demographics
NPI:1972298792
Name:LIFEHOUSE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:LIFEHOUSE BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:NCRS, MBA
Authorized Official - Phone:312-451-5996
Mailing Address - Street 1:12761 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2141
Mailing Address - Country:US
Mailing Address - Phone:708-897-8581
Mailing Address - Fax:
Practice Address - Street 1:12761 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2141
Practice Address - Country:US
Practice Address - Phone:708-897-8581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder