| NPI | 1336317254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN T STORTZ Chief Administrative Officer 815-741-7042 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2020-04-17 |