Provider Demographics
NPI:1518435247
Name:DAVIS FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:DAVIS FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN TONIELLI
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP APRN FNP-BC
Authorized Official - Phone:815-561-8500
Mailing Address - Street 1:1212 CURRENCY CT STE A
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-2321
Mailing Address - Country:US
Mailing Address - Phone:815-561-8500
Mailing Address - Fax:815-561-8501
Practice Address - Street 1:1212 CURRENCY CT STE A
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-2321
Practice Address - Country:US
Practice Address - Phone:815-561-8500
Practice Address - Fax:815-561-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1225553803OtherNPI