| NPI | 1649794686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNTI JOHNSON Member 916-801-8351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA SC60527686) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2022-07-21 |