| NPI | 1467034058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERI BOSSE Owner 681-265-1140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| 305S00000X Point of Service | |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2021-05-28 |