| NPI | 1114675246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE MBUYA Manager 508-344-7530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2025-04-11 |