| NPI | 1295232734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA J BISSELL COO 857-523-0654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: NM E7436) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2022-07-20 |