| NPI | 1073699914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK CARLSON Clinical Director 309-788-9581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 180001499) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-08-22 |