Provider Demographics
NPI:1639041429
Name:ELEGANCE RECOVERY HOUSE
Entity type:Organization
Organization Name:ELEGANCE RECOVERY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-328-3709
Mailing Address - Street 1:422 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:WORDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62097-1242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3679
Practice Address - Country:US
Practice Address - Phone:312-324-4991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging