| NPI | 1396456943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SRIHARI VEMURI CFO 815-444-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2024-10-08 |