| NPI | 1336635135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DONNER Owner/Member 847-957-3157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2018-07-03 |