LUTHERAN SOCIAL SERVICES OF ILLINOIS NPI 1932318920

NPI Information

NPI: 1932318920
Provider Name: LUTHERAN SOCIAL SERVICES OF ILLINOIS

Other Name: BHS KENMORE FACILITY

Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
5517 N KENMORE AVE
CHICAGO, IL
ZIP 60640
Phone: (773) 275-7962
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LUTHERAN SOCIAL SERVICES OF ILLINOIS is a rehabilitation and substance use disorder clinic center in Chicago, IL. LUTHERAN SOCIAL SERVICES OF ILLINOIS NPI is 1932318920. The provider is registered as an organization entity type.
The provider Other Name Is Bhs Kenmore Facility.

The provider's business location address is:

5517 N KENMORE AVE
CHICAGO, IL
ZIP 60640-515
Phone: (773) 275-7962
Fax: (773) 275-0728

The provider's authorized official is Mark Stutrud .
The authorized official title is President and has the following contact phone number (847) 390-4651.

The CLIA number assigned to this NPI record is 14D1053313 - other - hiv early interventions with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2007 and was last updated on 8/13/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	324500000X	Substance Abuse Rehabilitation Facility		A-0286-0011-A	ILLINOIS	No
2	324500000X	Substance Abuse Rehabilitation Facility		A-0286-0008-A	ILLINOIS	No
3	324500000X	Substance Abuse Rehabilitation Facility		A-0286-0012-A	ILLINOIS	No
4	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	A-0286-0009-A	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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