| NPI | 1154828770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DATHAN LANE Owner 253-750-2664 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251S00000X |
| 253Z00000X In Home Supportive Care | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1000X Clinic/Center, Migrant Health | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2021-08-24 |