| NPI | 1457912289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES MAIZE Cco 641-472-1684 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2021-10-18 |