| NPI | 1114280286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN PRONE Family Support Worker 508-580-4691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2012-06-22 |