| NPI | 1083125298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ANN SHANE Owner 309-369-3498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 180008837) |
| Enumeration Date | 2017-10-14 |
| Last Update Date | 2017-10-14 |