Organization
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Active
Other names
Dixon Prader Willi Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY NOONAN (CHIEF FINANCIAL OFFICER)
(847) 635-4600
Entity
Organization
Contact information
Practice address
314 S OTTAWA AVE, DIXON, IL 61021-3150
(815) 288-4108
(815) 288-2934
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
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
926169
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
926169
DEPT OF HUMAN SERVICES
IL
Enumeration date
04/08/2008
Last updated
04/08/2008
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