| NPI | 1861780025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL J DETAEGE President 773-988-4965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 149008180) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2011-07-20 |