| NPI | 1326779737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY SCOTT PHILLIPS Manager 980-284-1639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251X00000X Supports Brokerage |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2022-06-25 |