| NPI | 1003093121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NILDA RUIZ Executive Director 267-296-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: PA 134920) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2019-12-05 |