| NPI | 1093571275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA NELSON Owner 667-910-4615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult | |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-06-26 |