| NPI | 1194348359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUS VAN DEN BRINK Executive Director 708-730-6216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2020-05-22 |