| NPI | 1952418469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY DAVIS Revenue Cycle Manager 872-235-0258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 04029) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2025-04-08 |