NPI | 1548028962 |
---|---|
Entity Type | Organization |
Authorized Contact | TASHA AMICK Director Of Billing 909-382-7180 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
Enumeration Date | 2024-03-11 |
Last Update Date | 2024-03-11 |