| NPI | 1356596563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA COOPER Managed Care Supervisor 309-820-3535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X (Licence: IL A-0126-0002-A) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2019-01-31 |