| NPI | 1629424312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HASELEY Office Manager 217-422-6510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2016-05-11 |