| NPI | 1902593445 |
|---|---|
| Former Legal Business Name | LAKEVIEW PANTRY |
| Entity Type | Organization |
| Authorized Contact | JENNIFER FILICKY HULL Chief Program Officer 773-525-1777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2023-04-24 |