| NPI | 1801273446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE ISYANOV Clinical Services Director 847-673-8577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2016-09-02 |