| NPI | 1962166892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEATRIZ RAMIREZ Contracting And Credentialing 815-387-5623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2022-06-08 |