| NPI | 1508196494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE VANDYKE CLEVENGER CEO 217-362-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL A-0200-002-A) |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone (Licence: IL A-0200-002-A) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: IL A-0200-001-A) | |
| Enumeration Date | 2009-12-28 |
| Last Update Date | 2021-08-13 |