| NPI | 1619558574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISHUGHUN FAITH ORKAR Owner 224-999-0711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-20 |