| NPI | 1154848216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON MILLER Billing Analyst 309-687-7241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-6162-0001-A) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2017-08-29 |