| NPI | 1609144815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN MARIE TAYLOR Managed Care Supervisor 888-924-3786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: IL A-0126-0001-A) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0801X | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2023-03-16 |