| NPI | 1689192486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON MILLER Billing Analyst 309-687-7241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 2B05-IPI-130) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2017-09-01 |