| NPI | 1164060372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLANA BINKLEY Executive Assistant 419-502-2819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2024-06-05 |