| NPI | 1407277817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERIAN RENATA CARTER Owner 225-278-6607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 3687) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: LA 243896) |
| Enumeration Date | 2014-01-02 |
| Last Update Date | 2014-01-02 |