| 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 |