| NPI | 1124907852 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | DAVID STAMPLEY Manager 708-715-4713 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | 
| Enumeration Date | 2025-08-27 | 
| Last Update Date | 2025-08-27 |