| NPI | 1235912924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY DUNNING Credential/Contracting Manager 567-377-6316 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2023-09-21 |