NPI | 1639519960 |
---|---|
Entity Type | Organization |
Authorized Contact | CATHERINE BEAVERS Executive Director 815-557-7010 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 305R00000X) |
Enumeration Date | 2013-07-01 |
Last Update Date | 2013-07-01 |