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General NPI Number Information
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NPI Number | 1639041429
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Entity Type | Organization
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Legal Business Name | ELEGANCE RECOVERY HOUSE
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 900 S CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60605-3679
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Country | US
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Telephone | 312-324-4991
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Fax |
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Provider Business Mailing Address
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Address Line | 422 W WALL ST
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City | WORDEN
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State | IL
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Zip | 62097-1242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DYRA HOLT
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Credential |
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Telephone | 630-328-3709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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