| NPI | 1164980744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTICE OTCHERE President 682-433-9287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2024-09-30 |