| NPI | 1609284652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALI HEIMBACH Owner 267-597-1029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 1-13-15004) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2014-07-22 |