| NPI | 1518380740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELORA JON CUINGTON-HOLLAND General Manager 224-475-2105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2014-01-23 |