| NPI | 1215394853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGETTE D HERREN Owner/Licdc, Lsw 937-301-5549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: OH ICDC.141066) |
| Additional Taxonomies | 251S00000X (Licence: OH S.1201403) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-06-08 |