| NPI | 1225490915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE SPICER Registered Agent 217-801-1242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 149.016405) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: IL 149.018235) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-05-04 |