| NPI | 1407381064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LYNN GRIMES Owner 773-659-9207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 149009417) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2020-03-31 |