| NPI | 1811490030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEATRIZ RAMIREZ Managed Care Paneling Assistant 815-387-5623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2018-03-14 |