Healthcare Provider Details

I. General information

NPI: 1053359406
Provider Name (Legal Business Name): RRAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 SOUTH MAIN STREET
LOMBARD IL
60148
US

IV. Provider business mailing address

613 SOUTH MAIN STREET
LOMBARD IL
60148
US

V. Phone/Fax

Practice location:
  • Phone: 630-495-7723
  • Fax: 630-495-7723
Mailing address:
  • Phone: 630-495-7723
  • Fax: 630-495-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARILYN J FLANAGAN
Title or Position: EXECUTIVE DIRECTOR & SR. VP
Credential: QIDP
Phone: 630-495-7723