Organization Name: | ANN KILEY DEVELOPMENTAL CENTER UNIT 3369 HOME 29 |
NPI Number: | 1306974589 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PRATIHBA MALHOTRA (MEDICAL DIRECTOR) |
Mailing Address: | 1401 W Dugdale Rd Waukegan |
State: | IL US |
Postal Code: | 600856263 |
Phone Number: | 8472490600 |
Fax Number: | 8472494587 |
NPI Enumeration Date: | 03/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |