| NPI | 1215359492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE LARRY Director 815-621-6406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 261QA0600X Clinic/Center, Adult Day Care | |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2014-01-07 |