| NPI | 1962877332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HIREN PATEL Owner 224-577-5742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 019029817) |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit (Licence: IL 019029817) |
| 305S00000X Point of Service (Licence: IL 019029817) | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2015-12-10 |