| NPI | 1215696497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY NICHOLS CEO 267-597-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2025-07-01 |