| NPI | 1346993896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRY JOHNSON Waiver Support Coordinator 386-965-5418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2022-02-03 |