| NPI | 1104598374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILBERT YATES Contract Manager 877-262-7803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities | |
| 251S00000X | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2024-10-01 |