| NPI | 1619456159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL SHEETS Managed Care Contracting Assistant 815-387-5680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-07 |