| NPI | 1619840899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID OLATUNBOSUN FOWOPE CEO 765-209-8193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-09-24 |
| Last Update Date | 2025-12-28 |