| NPI | 1922617133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD MANKINEN Director 708-335-1155 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2020-11-24 |