Organization
ELECE DOUGLAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELECE DOUGLAS (DEVELOMENTAL THERAPIST)
(708) 335-3519
Entity
Organization
Contact information
Practice address
17309 HOLMES AVE, HAZEL CREST, IL 60429-1710
(708) 335-3519
(708) 335-3519
Mailing address
17309 HOLMES AVE, HAZEL CREST, IL 60429-1710
(708) 335-3519
(708) 335-3519
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/07/2009
Last updated
10/07/2009
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