| NPI | 1871378976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN SUZETTE PETERSON Director Of Quality Improvement 217-367-3728 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-08-28 |