| NPI | 1942037072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWINA SMITH CEO 224-477-4132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-09-13 |
| Last Update Date | 2024-09-13 |