| NPI | 1407375801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDY MILAR MOORE Owner 888-667-6467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR 200850112NP) |
| Enumeration Date | 2017-09-17 |
| Last Update Date | 2019-02-07 |