NPI | 1750626966 |
---|---|
Entity Type | Organization |
Authorized Contact | LISA KAY GUSTAFSON Treatment COO Rdinator 815-433-3953 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: IL 1041C0700X) |
Enumeration Date | 2012-11-29 |
Last Update Date | 2022-09-20 |