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General NPI Number Information
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NPI Number | 1619557659
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Entity Type | Organization
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Legal Business Name | RAY GRAHAM ASSOCIATION FOR PEOPLE WITH DISABILIT
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 1108 N MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-1362
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Country | US
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Telephone | 630-953-9574
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Fax |
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Provider Business Mailing Address
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Address Line | 901 WARRENVILLE RD STE 500
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City | LISLE
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State | IL
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Zip | 60532-4319
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Country | US
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Telephone | 630-620-2222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | KIMBERLY RAYE ZOELLER
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Credential |
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Telephone | 630-620-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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