| NPI | 1487179057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATINA RUSSELL Contract And Cred Specialist 312-663-1130 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2022-02-16 |