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General NPI Number Information
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NPI Number | 1609222652
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Entity Type | Organization
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Legal Business Name | KELLY ACCURATE DUI TREATMENT SERVICES, LLC
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 20550 S LAGRANGE RD LOWER LEVEL
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City | FRANKFORT
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State | IL
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Zip | 60423-1397
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Country | US
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Telephone | 815-630-8828
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Fax |
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Provider Business Mailing Address
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Address Line | 20550 S LAGRANGE RD LOWER LEVEL
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City | FRANKFORT
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State | IL
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Zip | 60423-1397
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Country | US
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Telephone | 815-630-8828
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Fax |
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Authorized Official
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Title or Position | OWNER /DIRECTOR
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Name | MISS RENEE PATRICE KELLY
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Credential | CADC
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Telephone | 708-323-8270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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