| NPI | 1194896944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORYCE MCCARTHY CFO 847-353-1758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: IL 036-078-450) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2021-04-20 |