NPI | 1760602593 |
---|---|
Entity Type | Organization |
Authorized Contact | MEGAN MARIE TAYLOR Managed Care Supervisor 888-924-3786 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 04023) |
Enumeration Date | 2007-04-26 |
Last Update Date | 2023-03-16 |