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Organization
GALENA CLINIC, INC.
Active
Organization
GALENA CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH P DAVIS MD (PRESIDENT)
(815) 777-1300
Entity
Organization
Contact information
Practice address
939 GALENA SQUARE DR, GALENA, IL 61036-1355
(815) 777-1300
(815) 777-1308
Mailing address
939 GALENA SQUARE DR, GALENA, IL 61036-1355
(815) 777-1300
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
A-6258-0001-A
IL
261QM2800X
Methadone Clinic
Primary
A-6258-0001-A
IL
Other
Enumeration date
04/07/2011
Last updated
01/04/2018
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