| NPI | 1003289323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL ALANA JACKSON Owner 641-278-1095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IA 00738) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IA 00738) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2024-01-26 |