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