NPI | 1295279503 |
---|---|
Entity Type | Organization |
Authorized Contact | BRIAN NOTTAGE Vice President 312-943-6545 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: IL A05210019A) |
Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
Enumeration Date | 2016-12-06 |
Last Update Date | 2020-01-29 |