| NPI | 1194094094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN NOTTAGE Vice President 224-659-7030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: IL A05210020A) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A05210020A) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2020-01-28 |