| NPI | 1679382204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDAN WAGNER Managing Director 773-554-5041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-01-07 |