| NPI | 1346932555 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | NANA A BAMFO Licensed Marriage Therapist 909-997-5863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 251K00000X Public Health or Welfare | |
| 251T00000X PACE Provider Organization | |
| 252Y00000X Early Intervention Provider Agency | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2023-05-24 |