| NPI | 1821457714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAMESH B VEMURI Owner 815-444-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 036054365) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2017-01-31 |