| NPI | 1235008269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENATA L RHODES Owner 469-200-9671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-10-29 |
| Last Update Date | 2025-12-08 |