| NPI | 1154895225 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARSHA JACKSON Auth 402-457-1215 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2021-03-19 |