| NPI | 1023516044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY LONG Executive Director 618-457-4151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-01-24 |