| NPI | 1841805595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE AMPADU Owner 815-274-5202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2020-09-10 |