Organization
LARC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORA HURLING (EXECUTIVE DIRECTOR)
(708) 474-1540
Entity
Organization
Contact information
Practice address
19043 WENTWORTH AVE, LANSING, IL 60438-3873
(708) 474-1540
Mailing address
19043 WENTWORTH AVE, P O BOX 77, LANSING, IL 60438-3873
(708) 474-1540
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/28/2015
Last updated
12/28/2015
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