| NPI | 1316356850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK RAY MA Clinical Supervisor 312-996-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 251K00000X Public Health or Welfare | |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2025-05-18 |