| NPI | 1295107753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIEU MA Director Of Operation 888-549-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: IL 533073-01) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: IL 533073-01) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2015-10-23 |