| NPI | 1912175159 |
|---|---|
| Other Name | 670-672 CHANEY CT |
| Entity Type | Organization |
| Authorized Contact | BENJAMIN STORTZ Chief Administrative Officer 815-741-7042 |
| 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 |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2020-07-30 |