| NPI | 1457750341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE VISNICK Project Director 866-472-9466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: PA 650054) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: PA 650054) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2017-04-21 |