| NPI | 1891151528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY PHILLIPS Accounts Receiveable De PT Manager 618-937-6483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2021-03-17 |