| NPI | 1235990326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE BLACK Provider Relations Manager 775-888-6610 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-01-17 |