| NPI | 1831864677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN NOEL EARHART Owner 815-520-3658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2021-08-13 |