| NPI | 1972623833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MARTIN President 815-338-7749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 149.003373) |
| Enumeration Date | 2007-04-01 |
| Last Update Date | 2020-08-22 |