| NPI | 1063642841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA DENISE SMITH Director Of Coding And Compliance 331-643-5238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QC1500X Clinic/Center, Community Health (Licence: IL 36383128) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2026-04-20 |