| NPI | 1588032536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONI MARIA BURROUGHS Program Manager 512-629-6458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |