| NPI | 1598307712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY MAGUIRE Credentialing Clerk 217-854-3166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2019-10-09 |