| NPI | 1285860205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE TEBBE Vice President 618-465-0044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: IL 94S229) |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: IL 94S229) | |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2022-07-21 |