| NPI | 1124521430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY BAZELON Member 847-707-5424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 180.010546) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2021-10-28 |