| NPI | 1497083547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FABRICE WILLIAM DOLCE Owner 541-884-6004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR 07-06-73u3) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: OR 07-06-73u3) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2009-12-01 |