| NPI | 1255485157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALESHA SYDNEY Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2010-08-03 |