| NPI | 1710049820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRON GRAHAM CEO 708-647-3305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-0621-0003-A) |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: IL a-0621-0003-a) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: IL a-0621-0004a) | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: IL a-0621-0002-a) | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: IL a-0621-0001-a) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2021-11-18 |