| NPI | 1649653510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANNA M. AMBROSE Interim CEO And President 800-836-0475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2015-07-09 |