| NPI | 1710519046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA JEFFERSON Registered Nurse 773-952-1965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2020-02-05 |