| NPI | 1104059864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSECA WATSON Credentialing Manager 630-572-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: IL 07008) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2020-10-22 |