| NPI | 1720467798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN HARRISON Owner 773-717-6759 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2015-05-23 |
| Last Update Date | 2015-05-23 |