| NPI | 1124660444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI BLACK Billing Manager 216-512-5929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2019-10-09 |