| NPI | 1912749540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESTINA CABAN D Irector 312-172-4589 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| 251S00000X | |
| 251V00000X Voluntary or Charitable | |
| 252Y00000X Early Intervention Provider Agency | |
| 261Q00000X Clinic/Center | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QH0700X Clinic/Center, Hearing and Speech | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QR1300X Clinic/Center, Rural Health | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 385HR2050X Respite Care, Respite Care Camp | |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-08-07 |