| NPI | 1609953223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ARELLANO Controller 815-723-3405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: IL 310-492) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-11-30 |