| NPI | 1104698422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KEENAN Executive Director 435-680-1459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2023-11-01 |