| NPI | 1679080915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA A GOOD VP/CFO 815-284-6611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2021-07-01 |