| NPI | 1801097100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCO E JACOME Executive Director 773-252-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-0589-0010-A) |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic (Licence: IL A-0589-0010-A) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2023-02-21 |