Provider Demographics
NPI:1619557659
Name:RAY GRAHAM ASSOCIATION FOR PEOPLE WITH DISABILIT
Entity Type:Organization
Organization Name:RAY GRAHAM ASSOCIATION FOR PEOPLE WITH DISABILIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:ZOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-620-2222
Mailing Address - Street 1:901 WARRENVILLE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4319
Mailing Address - Country:US
Mailing Address - Phone:630-620-2222
Mailing Address - Fax:
Practice Address - Street 1:1108 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1362
Practice Address - Country:US
Practice Address - Phone:630-953-9574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health