| 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 |