Provider Demographics
NPI:1487310074
Name:KELLY COMPANIES, LLC
Entity type:Organization
Organization Name:KELLY COMPANIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:TISA
Authorized Official - Last Name:COFFEY-KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-880-8727
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:DONNELLY
Mailing Address - State:ID
Mailing Address - Zip Code:83615-0416
Mailing Address - Country:US
Mailing Address - Phone:208-880-8727
Mailing Address - Fax:
Practice Address - Street 1:13019 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:DONNELLY
Practice Address - State:ID
Practice Address - Zip Code:83615
Practice Address - Country:US
Practice Address - Phone:208-880-8727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELLY COMPANIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty