Provider Demographics
NPI:1962856831
Name:RAY GRAHAM ASSOCIATION
Entity Type:Organization
Organization Name:RAY GRAHAM ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-628-7255
Mailing Address - Street 1:901 WARRENVILLE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4301
Mailing Address - Country:US
Mailing Address - Phone:630-620-2222
Mailing Address - Fax:630-628-1488
Practice Address - Street 1:901 WARRENVILLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4301
Practice Address - Country:US
Practice Address - Phone:630-620-2222
Practice Address - Fax:630-628-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL199100030C320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities