| NPI | 1427745694 |
|---|---|
| Doing Business As | JACOB PAGE |
| Entity Type | Organization |
| Authorized Contact | JACOB KILSON PAGE Owner 857-488-0632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-04-19 |