| NPI | 1033570262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MARKLEY CEO 618-937-6483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-0234-0010-A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QM2800X Clinic/Center, Methadone Clinic (Licence: IL A-0234-0010-A) | |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2020-03-23 |