| NPI | 1285874529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J MAICHLE BACON Administrator 815-720-4210 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: IL 14D0430142) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2009-04-17 |