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KELLY DOUGLAS
NPI 1093541831
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Jefferson, WI

Active since September 09, 2024
910 HILLSIDE DR, JEFFERSON, WI 53549(920) 650-0027 Get Directions Write a Review

NPPES record last updated: September 9, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Kelly Douglas NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY DOUGLAS (NPI 1093541831) is an individual community based residential treatment facility, intellectual and/or developmental disabilities provider in Jefferson, Wisconsin and active in the NPI registry since September 2024.

NPPES Registry Identity

NPI1093541831
Entity TypeIndividualFemale
Primary Taxonomy320900000X
Provider Legal NameKELLY DOUGLAS
Location Address910 HILLSIDE DRJefferson, WI 53549-1823
Mailing Address910 Hillside DrJefferson, WI 53549-1823 · (920) 650-0027
Phone(920) 650-0027
Sole ProprietorYes
Enumeration DateSeptember 9, 2024
NPPES CertifiedSeptember 9, 2024
✔ NPI 1093541831 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320900000X
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
910 HILLSIDE DR, Jefferson, WI 53549
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Douglas's NPI number?

The NPI number for Kelly Douglas is 1093541831. It was assigned to this individual provider in the NPPES registry on September 9, 2024.

Where is Kelly Douglas located?

Kelly Douglas practices at 910 Hillside Dr, Jefferson, WI 53549. The listed phone number is (920) 650-0027.

What is Kelly Douglas's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for Kelly Douglas was last updated on September 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.