| NPI | 1720441124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CORSO Director 224-436-7392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 149.012248) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2017-03-10 |