| NPI | 1437799830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN SHEPHERD Director Of Revenue Cycle 833-378-4827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2025-01-03 |