| NPI | 1174228639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CHRISTOPHER Contracting Credentialing Coordinat 563-327-0203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2025-04-11 |