Provider Demographics
NPI:1558874743
Name:KELLY-NORTON PROGRAMS, INC.
Entity Type:Organization
Organization Name:KELLY-NORTON PROGRAMS, INC.
Other - Org Name:STEVENS HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:W
Authorized Official - Last Name:AYLWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA LP
Authorized Official - Phone:763-544-1447
Mailing Address - Street 1:6739 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4618
Mailing Address - Country:US
Mailing Address - Phone:763-544-1447
Mailing Address - Fax:763-544-0833
Practice Address - Street 1:1928 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3835
Practice Address - Country:US
Practice Address - Phone:612-879-9035
Practice Address - Fax:612-879-8462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELLY-NORTON PROGRAMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging