| NPI | 1477389716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY R MCKENNEY Owner 815-408-1262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2024-09-12 |