1427048826 NPI number — LUTHERAN SOCIAL SERVICES OF ILLINOIS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427048826 NPI number — LUTHERAN SOCIAL SERVICES OF ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427048826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 E TOUHY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60018-5817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-635-4600
Provider Business Mailing Address Fax Number:
847-390-1426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 PARKVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61107-1899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-399-8832
Provider Business Practice Location Address Fax Number:
815-399-8342
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NOONDUV
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
EDMUND
Authorized Official Title or Position:
VP FINANCE CFO
Authorized Official Telephone Number:
847-635-4600

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0021238 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0021238 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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