| NPI | 1619500469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNELISE HEITMAN Owner 541-214-3465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2020-02-20 |