NPI | 1003384686 |
---|---|
Entity Type | Organization |
Authorized Contact | NICOLE WATKINS Manager, Payer Services 346-318-4941 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2018-11-13 |
Last Update Date | 2024-07-01 |