| NPI | 1114497906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL KENNETH LAURIDSEN Exrecutive Director 815-744-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2018-12-05 |