| NPI | 1760091508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT TAYLOR CFO 815-320-7190 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2020-07-28 |