| NPI | 1063946747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TENNILLE HARRIS Human Resource Director 877-290-0201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MD MH00000101) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2022-01-18 |