| NPI | 1508480765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILES RAIZADA Provider 940-220-8899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 251S00000X |
| 261QE0002X Clinic/Center, Emergency Care | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2021-08-16 |