| NPI | 1891827655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNA BOLEN Owner 773-327-9356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 071-006419) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2009-06-29 |