| NPI | 1518263144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RIVES W THORNTON Member 304-319-0581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA 603324417) |
| Enumeration Date | 2011-01-29 |
| Last Update Date | 2016-12-12 |