| NPI | 1528932605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUBI BOLLES Owner 224-338-6103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-10-02 |
| Last Update Date | 2026-01-19 |