| NPI | 1164026589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY A KELLER CEO 870-336-8100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2020-12-18 |