| NPI | 1275210213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DICKSON E IDUSUYI CEO 225-610-5376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2023-06-30 |