| NPI | 1518371244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY NUELLE Director 217-821-9539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: MT 31471) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-20 |