| NPI | 1194488205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA HOLLOMAN Quality Assurance Director 267-984-9775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2021-10-15 |