| NPI | 1235680711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY STOUT Chairman 870-273-5376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |