| NPI | 1609273937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRIN G. MYERS Chief Operating Officer 815-290-0902 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2018-06-26 |