| NPI | 1356693485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESHAUNA LEWIS Owner 443-631-0445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 251S00000X |
| 302R00000X Health Maintenance Organization | |
| 305S00000X Point of Service | |
| 305R00000X Preferred Provider Organization | |
| 302F00000X Exclusive Provider Organization | |
| Enumeration Date | 2012-10-13 |
| Last Update Date | 2012-10-13 |