| NPI | 1104154277 |
|---|---|
| Doing Business As | PEORIA SITE 014030 |
| Entity Type | Organization |
| Authorized Contact | VIVIANE NGWA Executive Director 708-679-9137 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency |
| Additional Taxonomies | 251B00000X Case Management |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2010-12-03 |