| NPI | 1063779460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA JEAN BEYNON Owner/Director 855-692-7247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OH I.0700055-SUPV) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2022-07-21 |