| NPI | 1013163252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON QUANDT Executive Director 217-347-7179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: IL 91S064) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2018-11-29 |