| NPI | 1285913590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOREEN SAMELSON Behavioral Health Manager Iii 209-858-7754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 27250) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2011-08-04 |