| NPI | 1477686780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE L PRUIM Administrator 815-941-3113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2019-08-20 |