| NPI | 1508169913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOB TAYLOR CFO 815-320-7190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2020-05-20 |