| NPI | 1609388602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM MARIA WARNER Manager 904-699-0032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV NV20171265805) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2018-06-16 |