| NPI | 1306436159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNATHAN ERIC FOURTHMAN President/Owner 239-888-3111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2021-01-25 |