| NPI | 1164949574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY M. MARTIN CFO 708-825-5976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |