| NPI | 1609576214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTON CARLSON Director 815-387-5664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-03-03 |