| NPI | 1174583660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON MILLER Billing Analyst 309-687-7241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| 251V00000X Voluntary or Charitable | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2017-11-06 |