| NPI | 1316068471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN MARIE TAYLOR Managed Care Supervisor 888-924-3786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-0126-0002-A) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: IL A-0126-0003-A) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2023-03-16 |