| NPI | 1043708134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD ADELMAN CFO 815-901-6866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2019-02-13 |