| NPI | 1003256082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE ANN JENSEN President/Owner 712-301-4518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NE 569) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NE 901) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2014-12-31 |