| NPI | 1609013077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY MAENLE Billing Assistant 847-952-7460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 04005) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2022-07-25 |