Organization
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Active
Other names
Shady Oaks Developmental Training Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD NOONAN (CHIEF FINANCIAL OFFICER)
(847) 635-4600
Entity
Organization
Contact information
Practice address
16248 S PARKER RD, HOMER GLEN, IL 60491-9081
(708) 301-3885
(708) 301-1509
Mailing address
1001 E TOUHY AVE, SUITE 170, DES PLAINES, IL 60018-5801
(847) 635-4600
(847) 297-3407
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
—
—
163W00000X
Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199200169C
STATE OF ILLINOIS DEPARTMENT OF HUMAN SERVICES
IL
Enumeration date
06/29/2016
Last updated
06/29/2016
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