| NPI | 1942894761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA NICHOLAS Owner 708-541-5006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2021-05-18 |