| NPI | 1568249001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES JERRY PETERSON Special Instruction 916-627-5859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-09-08 |
| Last Update Date | 2023-09-08 |