| NPI | 1831248228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD L BOOKER Administrator 815-468-6581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: IL 0042218) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: IL 0042218) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2010-07-15 |