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General NPI Number Information
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NPI Number | 1962856831
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Entity Type | Organization
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Legal Business Name | RAY GRAHAM ASSOCIATION
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 901 WARRENVILLE RD SUITE 500
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City | LISLE
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State | IL
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Zip | 60532-4301
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Country | US
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Telephone | 630-620-2222
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Fax | 630-628-1488
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Provider Business Mailing Address
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Address Line | 901 WARRENVILLE RD SUITE 500
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City | LISLE
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State | IL
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Zip | 60532-4301
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Country | US
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Telephone | 630-620-2222
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Fax | 630-628-1488
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | KIMBERLY ZOELLER
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Credential |
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Telephone | 630-628-7255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 199100030C
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License Number State | IL
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