| NPI | 1396818936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY D MAHONEY Director 712-396-0290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 05908) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2020-08-22 |