| NPI | 1184176604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENDA DEE ARMSTRONG Member Manager 318-218-0694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 3174) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-11-01 |