| NPI | 1073405270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANTON RISSER A CFO 260-266-9380 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2025-08-12 |