| NPI | 1205338993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKIE STULL Information Services Specialist 217-223-0423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2018-03-08 |