| Organization Name: | LUTHERAN SOCIAL SERVICES OF ILLINOIS |
| NPI Number: | 1013310705 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK STUTRUD (CEO) |
| Mailing Address: | 1111 S Alpine Rd Suite 201 Rockford |
| State: | IL US |
| Postal Code: | 611083940 |
| Phone Number: | 8153879170 |
| Fax Number: | 8153879171 |
| NPI Enumeration Date: | 10/08/2014 |
| NPI Last Update Date: | 10/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 3000426 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |