| NPI | 1922277631 |
|---|---|
| Other Name | DASA MEDICAID PROVIDER |
| Entity Type | Organization |
| Authorized Contact | MICHAEL FLORA CEO/President 815-756-4875 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: IL A0254001A) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2008-04-20 |