| NPI | 1407469034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTOINETTE POULSON Program Administrator 775-677-2216 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2020-08-24 |