| NPI | 1174084677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA J ANGLIN Controller 217-352-0099 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |