| NPI | 1326674995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA BECHARD Billing & Claims Specialist 217-323-2980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2020-03-16 |