| NPI | 1265328751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA S WAGNER Doo 530-310-2150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2025-06-16 |