Provider Demographics
NPI:1992070031
Name:LAKAR ENTERPRISE LLC
Entity type:Organization
Organization Name:LAKAR ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MHS,CADC, DASA
Authorized Official - Phone:708-263-9512
Mailing Address - Street 1:3343 171ST ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1105
Mailing Address - Country:US
Mailing Address - Phone:708-263-9512
Mailing Address - Fax:
Practice Address - Street 1:15525 S PARK AVE STE 114
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1380
Practice Address - Country:US
Practice Address - Phone:708-263-9512
Practice Address - Fax:708-825-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 276400000X
ILA58520002A251S00000X
IL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No276400000XHospital UnitsRehabilitation, Substance Use Disorder UnitGroup - Multi-Specialty