| NPI | 1609766849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKENSY LEIGH ELLIS-WHITE Owner 217-213-6114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-07-08 |