| NPI | 1639614175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SRIHARI VEMURI CFO 815-444-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2024-10-08 |