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NPI Code Detail

MEDICARE: ANN KILEY DEVELOPMENTAL CENTER UNIT 3263

MEDICARE: ANN KILEY DEVELOPMENTAL CENTER UNIT 3263
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number : 1922135441
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANN KILEY DEVELOPMENTAL CENTER UNIT 3263
Provider Business Mailing Address
First Line : 1401 W DUGDALE RD
Second Line :
City : WAUKEGAN
State : IL
Zip : 60085-6263
Country : US
Telephone Number : 847-249-0600
Fax Number : 847-249-4587
Provider Business Practice Location Address
First Line : 1401 W DUGDALE RD
Second Line :
City : WAUKEGAN
State : IL
Zip : 60085-6263
Country : US
Telephone Number : 847-249-0600
Fax Number : 847-249-4587
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. PRATIHBA MALHOTRA
Credential : M.D.
Telephone Number : 847-249-0600
Provider Enumeration Date : 02/28/2007
Last Update Date : 08/22/2020

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Directions to “ANN KILEY DEVELOPMENTAL CENTER UNIT 3263 ” Practice Location

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