| NPI | 1336617869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM FEAR Hr & Finance 815-432-5241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-11-02 |