| NPI | 1245944008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA CARNEY CEO 618-956-9521 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 101YM0800X Counselor Mental Health | |
| 1041C0700X Social Worker Clinical | |
| 1223G0001X Dentist General Practice | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2024-07-29 |