NPI | 1477258655 |
---|---|
Former Legal Business Name | LAKEVIEW PANTRY |
Entity Type | Organization |
Authorized Contact | KELLIE O'CONNELL Chief Executive Officer 773-525-1777 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
Enumeration Date | 2023-04-05 |
Last Update Date | 2023-04-24 |