| NPI | 1982259693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY IDE Managed Care Specialist 224-659-7030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 251S00000X |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2019-12-13 |