Organization
ELIJAH'S JOURNEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE LARRY MBA (DIRECTOR)
(815) 621-6406
Entity
Organization
Contact information
Practice address
269 TECUMSEH DR, BOLINGBROOK, IL 60490-5564
(815) 621-6406
Mailing address
269 TECUMSEH DR, BOLINGBROOK, IL 60490-5564
(815) 621-6406
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/07/2014
Last updated
01/07/2014
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