| NPI | 1205594157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMANDA GOINS Admin 725-231-4493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2021-12-07 |