| NPI | 1629724372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH OLIVIA GOVAN CEO 854-444-9973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 251E00000X Home Health |
| 251J00000X Nursing Care | |
| 252Y00000X Early Intervention Provider Agency | |
| 253Z00000X In Home Supportive Care | |
| 261Q00000X Clinic/Center | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 261QC1800X Clinic/Center, Corporate Health | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QP2400X Clinic/Center, Prison Health | |
| 261QS1000X Clinic/Center, Student Health | |
| 261QV0200X Clinic/Center, VA | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | |
| 3747A0650X Technician, Attendant Care Provider | |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2023-02-20 |