| NPI | 1053337493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REYNALDO A DE LOS ANGELES Medical Director 308-384-4739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2008-09-11 |