| NPI | 1174976757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER LACINA Medical Director 319-291-2455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 313M00000X Nursing Facility/Intermediate Care Facility | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2025-01-16 |