| NPI | 1326844267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY EDWARD ELLIS Controller 870-336-8100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-02-21 |