| Organization Name: | LUTHERAN SOCIAL SERVICES OF IL |
| NPI Number: | 1174576862 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GERALD EDMUND NOONAN (V.P. FINANCE/CFO) |
| Mailing Address: | 3000 W Rohmann Ave West Peoria |
| State: | IL US |
| Postal Code: | 616044842 |
| Phone Number: | 3096710300 |
| Fax Number: | 3096710503 |
| NPI Enumeration Date: | 05/17/2006 |
| NPI Last Update Date: | 05/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 04092 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |