| NPI | 1073759825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL K LAURIDSEN Executive Director 815-744-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2017-07-18 |