| NPI | 1023754231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FATIATU JOBI Owner 301-937-0188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2022-05-10 |