| NPI | 1164065892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN TAIMAN Payor Relations Specialist 888-428-3223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2023-10-06 |