| NPI | 1316307259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAMESH VEMURI Owner 815-444-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 036054365) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2017-01-26 |