| Lifeskills Center, Ltd | |
|
479 North Ave Antioch IL 60002-1323 | |
| (224) 577-5022 | |
| (847) 395-9551 |
| Full Name | Lifeskills Center, Ltd |
|---|---|
| Speciality | Social Worker |
| Location | 479 North Ave, Antioch, Illinois |
| Authorized Official Name and Position | Susan A White (OWNER) |
| Authorized Official Contact | 2245775022 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeskills Center, Ltd 479 North Ave Antioch IL 60002-1323 Ph: (224) 577-5022 | Lifeskills Center, Ltd 479 North Ave Antioch IL 60002-1323 Ph: (224) 577-5022 |
| NPI Number | 1063623940 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 08/18/2023 |
| Certification Date | 08/18/2023 |
| Medicare PECOS PAC ID | 5597857862 |
|---|---|
| Medicare Enrollment ID | O20070816000802 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063623940 | NPI | - | NPPES |
| 11722321 | Other | IL | CAQH |
| 1508919812 | Other | IL | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149011526 (Illinois) | Primary |
| Provider Name | Susan A White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508919812 PECOS PAC ID: 7810091378 Enrollment ID: I20070323000032 |
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