| NPI | 1114416690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL SHEETS Managed Care Contracting Assistant 815-387-5680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2022-06-10 |