| NPI | 1093386450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNEST KWESI AMPONSAH Administrator 224-595-0112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2021-07-07 |