| NPI | 1619620937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE M SPELLIS-FREYRE Authorized Official 419-740-3022 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2023-09-29 |