| NPI | 1508748369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY NICHOLS CEO 267-597-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-09-03 |