| NPI | 1790847119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN NOTTAGE Vice President 312-943-6545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone (Licence: IL A05210004A) |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: IL A05210004A) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2021-03-12 |