| NPI | 1174483440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOSHA HALL Owner 346-347-6011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-11-17 |
| Last Update Date | 2025-12-03 |