| NPI | 1003697798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH KENNETH MCCOY Owner/Executive Director 267-709-1186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2023-10-10 |