| NPI | 1922879154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL VICK CFO 815-312-6821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2024-01-16 |