| NPI | 1194587402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MICHELLE BRACEY Director 346-229-7788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-01-23 |