Organization
GARDEN OF PRAYER YOUTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL MALONEY MBA, LCPC (EXECUTIVE DIRECTOR)
(815) 933-2493
Entity
Organization
Contact information
Practice address
16424 EAST STATE ROUTE 114, MOMENCE, IL 60954
(815) 472-2490
Mailing address
657 E COURT ST, KANKAKEE, IL 60901-4055
(815) 933-2493
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
041-129-294
IL
Other
Enumeration date
10/30/2012
Last updated
10/30/2012
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