| NPI | 1083982599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG DOUGLASS Administrator 4123-234-4543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: PA cw013707) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |