| NPI | 1104004621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKASHA MCINTOSH Director Of Billing 773-722-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2020-10-21 |