| NPI | 1811353535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY PHILLIPS Accounts Receiveable Dept Manager 618-937-6483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2020-09-11 |