| NPI | 1497511422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA NICOLE PRIMM VP Payer Relations 815-529-3907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2024-05-21 |