| NPI | 1346694957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN STORTZ CEO 815-741-7042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL 058150001) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2020-04-17 |