| NPI | 1073031357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VAHAN OGANESYAN COO 833-224-5538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X Community/Behavioral Health | |
| 261QD0000X Clinic/Center Dental | |
| 261QE0002X Clinic/Center Emergency Care | |
| 261QH0100X Clinic/Center Health Service | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QP2300X Clinic/Center Primary Care | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 261QR0800X Clinic/Center Recovery Care | |
| 261QU0200X Clinic/Center Urgent Care | |
| 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2023-12-04 |