NPI | 1366179806 |
---|---|
Doing Business As | LCH-PEDS BEHAVIORAL HEALTH LA |
Entity Type | Organization |
Authorized Contact | JOSEPH NIEBERGALL Credentialing Specialist 239-424-1446 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
Enumeration Date | 2022-08-04 |
Last Update Date | 2024-07-24 |