| NPI | 1518704964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL VICK CFO 815-312-6821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2024-08-06 |