| NPI | 1760618433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DAVID ROTH Medical Director 312-782-6466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 036059165) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2009-06-08 |