| NPI | 1184241275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSECA WATSON Credentialing Manager 630-572-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2020-07-06 |