| NPI | 1255704573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDE N/A JENKINS-SCHRACK Owner 702-279-8679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AK BEVB10) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2015-11-09 |