| NPI | 1114632072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OWEN GARDNER Owner 301-928-4725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2023-01-19 |