| NPI | 1922010362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL K LAURIDSEN Executive Director 815-744-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2017-07-18 |