| NPI | 1407026511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHELEASE MACHAY PARKS Director Of State Programs 309-799-7044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2020-09-17 |