| NPI | 1174954937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOB TAYLOR CFO 815-320-7190 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2020-05-20 |