| NPI | 1083978324 |
|---|---|
| Former Legal Business Name | PROVISO FAMILY SERVICES |
| Entity Type | Organization |
| Authorized Contact | DONALD PINKSTON Manager 708-681-0073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 178.007422) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2012-07-02 |