| NPI | 1104503879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL SANDOVAL Owner 860-916-0801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2023-07-03 |