| NPI | 1588503460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE OCKEY CFO 385-371-4515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2026-03-26 |
| Last Update Date | 2026-03-26 |