| NPI | 1194021485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN TAYLOR Managed Care Supervisor 888-924-3786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 04023) |
| Additional Taxonomies | 251B00000X Case Management (Licence: IL 04023) |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2021-02-25 |