Provider Demographics
NPI:1528195070
Name:ANN KILEY DEVELOPMENTAL CENTER UNIT 3163
Entity Type:Organization
Organization Name:ANN KILEY DEVELOPMENTAL CENTER UNIT 3163
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIHBA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-249-0600
Mailing Address - Street 1:1401 W DUGDALE RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-6263
Mailing Address - Country:US
Mailing Address - Phone:847-249-0600
Mailing Address - Fax:847-249-4587
Practice Address - Street 1:1401 W DUGDALE RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-6263
Practice Address - Country:US
Practice Address - Phone:847-249-0600
Practice Address - Fax:847-249-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities