| NPI | 1558247924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY RICHARDSON Owner 773-679-9641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2025-08-12 |
| Last Update Date | 2025-08-12 |