| NPI | 1740516640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROLAND EDWARD WESLEY CEO 773-261-0075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: IL 946213) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: IL YESU) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2009-10-27 |