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General NPI Number Information
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NPI Number | 1306417944
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Entity Type | Organization
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Legal Business Name | DUI DEPOT, LLC
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 25 N RIVER LN # 114
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City | GENEVA
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State | IL
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Zip | 60134-2263
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Country | US
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Telephone | 224-499-3699
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Fax | 888-740-7373
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Provider Business Mailing Address
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Address Line | 25 N RIVER LN # 114
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City | GENEVA
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State | IL
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Zip | 60134-2263
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Country | US
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Telephone | 224-499-3699
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Fax | 888-740-7373
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | STEPHANIE EDDINGTON
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Credential | MA, CADC
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Telephone | 773-707-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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