| NPI | 1528724051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE BERNARD Interim CEO / CFO 618-242-1070 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2021-11-10 |