| NPI | 1205564549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA LOPEZ CEO 424-450-7412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2022-08-14 |
| Last Update Date | 2022-08-14 |