| NPI | 1114757515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JOLLY CEO 845-220-3165 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2024-08-02 |