| NPI | 1144718172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL M JACKS Sole Member 412-213-8425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: PA MF000999) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-05-01 |