| NPI | 1295421709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE M BURNSIDE Program Coordinator 870-415-9993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 252Y00000X Early Intervention Provider Agency | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-04-17 |