| NPI | 1013309657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HYDEE WARREN COO 904-294-5329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251B00000X Case Management (Licence: FL 012289300) |
| 251S00000X | |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2024-10-10 |