| NPI | 1205682119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATINA RUSSELL Credentialing Specialist 312-663-1130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-04-30 |