| NPI | 1265904163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEVIN BRITTAIN CEO 833-832-4767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251E00000X Home Health |
| 251S00000X | |
| 261Q00000X Clinic/Center | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| 314000000X Skilled Nursing Facility | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2018-12-18 |