| NPI | 1073067138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DAVIS President 815-777-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 14011) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: IL 14011) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: IL 14011) | |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2018-06-05 |