| NPI | 1093167660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ORALIA CAMPOS Senior Billing Manager 815-444-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2018-10-26 |