| NPI | 1407618697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUS VAN DEN BRINK President/CEO 708-730-6216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2024-02-05 |