| NPI | 1245602044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENIA ASOTA Director 309-269-0798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH4681) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH4681) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2015-10-20 |