| NPI | 1770014375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL KENNETH LAURIDSEN Executive Director 815-744-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 17005) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |