| NPI | 1255795902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA BECHARD Billing And Claims Specialist 217-323-2980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2020-03-10 |