| NPI | 1770117475 |
|---|---|
| Doing Business As | DEBRA CIASULLI |
| Entity Type | Organization |
| Authorized Contact | ALFRETA DANIEL Billing Manager 815-450-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-03-03 |