| NPI | 1982386702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN COKLOW CFO 773-597-7698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-08-02 |