| NPI | 1710584487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENZY LEE RICHARDSON Director Of Contract Administration 312-756-6230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |