| NPI | 1184359168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDEN FASKEN Chief Operating Officer 815-780-0690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2024-04-17 |