| NPI | 1407364086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH BORNER Manager 725-502-4846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV 82365726) |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2018-01-17 |