| NPI | 1952589715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENZY RICHARDSON Director Of Contract Administration 312-441-9009 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2020-08-12 |