| NPI | 1114609252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEATRIX MAYENGA Owner 316-461-1823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-07 |