Organization
GALENA CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH DAVIS M.D., PH.D. (PRESIDENT)
(815) 777-1300
Entity
Organization
Contact information
Practice address
939 GALENA SQUARE DR, GALENA, IL 61036
(815) 777-1300
(815) 777-1308
Mailing address
939 GALENA SQUARE DR, GALENA, IL 61036-1355
(815) 777-1300
(815) 777-1308
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
14011
IL
261QM0850X
Adult Mental Health Clinic/Center
14011
IL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
14011
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14011
MENTAL HEALTH
IL
Enumeration date
08/06/2016
Last updated
06/05/2018
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