| NPI | 1568610723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELVENTRE' SHYTEL SOUTHERLAND CEO 910-978-9118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251B00000X Case Management | |
| 251E00000X Home Health | |
| 251S00000X | |
| 251S00000X | |
| 252Y00000X Early Intervention Provider Agency | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 302F00000X Exclusive Provider Organization | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
| 341600000X Ambulance | |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2008-08-29 |