| NPI | 1578366530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE D. EWALD Contract And Compliance Specialist 937-414-1948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-03-27 |
| Last Update Date | 2025-03-27 |