| NPI | 1639628977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE ELIZABETH BLIVEN RANDOL Co Owner 401-529-3078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO 2015002575) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |