| NPI | 1366855223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA HENRY CFO 870-508-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 273R00000X Psychiatric Unit |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2024-03-01 |