| NPI | 1740093319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY SUEANN MCKENZIE Program Manager 312-468-1433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-01-28 |
| Last Update Date | 2025-07-18 |