| NPI | 1003499708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL SPENCER CREITZ General Counsel 620-240-5015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2021-04-30 |