| NPI | 1104230077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLADYS LANG Manager 872-207-5028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 04826191) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2014-06-18 |