| NPI | 1205816345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN T STORTZ Chief Administrative Officer 815-741-7042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2021-06-22 |