| NPI | 1316265143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUANE KELLOGG Clinical Director 1877-847-3639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CT 001291) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2010-05-04 |