NPI | 1366777229 |
---|---|
Entity Type | Organization |
Authorized Contact | KYLE JACOB COO 318-746-0420 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X |
Additional Taxonomies | 251S00000X Community/Behavioral Health |
Enumeration Date | 2009-10-11 |
Last Update Date | 2023-07-24 |