Organization
LAWRENCE HALL YOUTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK D. NUFER (CHIEF FINANCIAL OFFICER)
(773) 728-2807
Entity
Organization
Contact information
Practice address
4833 N FRANCISCO AVE, CHICAGO, IL 60625-3640
(773) 769-3500
(773) 769-6467
Mailing address
2737 W PETERSON AVE, CHICAGO, IL 60659-3927
(773) 728-2807
(773) 728-0751
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
012231-09, 012232-19
IL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
012231-09, 012232-19
IL
Other
Enumeration date
03/21/2006
Last updated
05/17/2012
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