Portage Cragin Outpatient

LBN: Lutheran Social Services Of Illinois
Portage Cragin Outpatient is an health care organization with primary practice located at 4840 W Byron St , Chicago IL 60641-2712. The organization recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Allopathic & Osteopathic Physicians / Family Medicine, Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) is the primary health care specialty. Lutheran Social Services Of Illinois can be contacted via phone (773) 282-7800, or through Stutrud, Mark via phone (847) 635-4600.

Contact Information

Primary practice address
4840 W Byron St Chicago IL 60641-2712
Phone: (773) 282-7800
Fax: (773) 282-2163
Website:
Map and Directions
Authorized official contact:
Name: Stutrud, Mark
Phone: (847) 635-4600

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X
Behavioral Health & Social Service Providers / Clinical 1041C0700X
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X

Profile Details

NPI number 1063637684
LBN Legal business name Lutheran Social Services Of Illinois
DBA Doing business as Portage Cragin Outpatient
Authorized official Stutrud, Mark
Entity Organization
Organization subpart 1 No
Enumeration date Apr 17th, 2007
Last updated Dec 31st, 2019 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063637684 NPPES
Illinois Other 0001618748 BLUE CROSS BLUE SHIELD

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