NPI | 1164255733 |
---|---|
Entity Type | Organization |
Authorized Contact | PRINCESS GEHYIGON WALLACE Owner 763-913-8125 |
Organization Subpart ? | No |
Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
Enumeration Date | 2024-08-20 |
Last Update Date | 2025-06-23 |