| NPI | 1437127131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE O'BRIEN Director Of Finance 815-963-0683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: IL 04130) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2024-06-25 |