| NPI | 1316400088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ENASHA L JAMES Medical Administrator 980-237-4768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health |
| Additional Taxonomies | 261QM0801X |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 291U00000X Clinical Medical Laboratory | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2020-12-17 |