| NPI | 1619273273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSAY GILLERAN Owner 917-881-4058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 1106983) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2011-01-31 |