Organization
MAITRI PATH TO WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDEN FASKEN (CHIEF OPERATING OFFICER)
(815) 780-0690
Entity
Organization
Contact information
Practice address
101 W WILLIAMS ST, WYOMING, IL 61491-1347
(815) 780-0690
(815) 410-1937
Mailing address
710 PEORIA ST, PERU, IL 61354-3262
(815) 780-0690
(815) 410-1937
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
03/12/2025
Last updated
03/12/2025
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