| NPI | 1073237848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RIA TYLER Director 708-970-4019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2024-01-09 |