| NPI | 1649778127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC SHAPIRO CFO 667-239-3293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2021-06-10 |