| NPI | 1013331255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HALLIE SHEADE Director 224-715-2995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 67848) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-07 |