| NPI | 1629255955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY C SALLIS Director 641-275-1119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 1312) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2022-01-19 |