| NPI | 1962814178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANNY GORDON Owner 312-952-8608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 101Y00000X) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2014-05-22 |