| NPI | 1952726010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE ISYANOV Clinical Services Director 847-922-4326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL A-1587-0007-A) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2016-09-03 |