| NPI | 1609249697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BYESHEBA ENTZMINGER-BULLOCK Owner/Administrator 571-403-9871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |