| NPI | 1679176903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALISTA CHANA CEO 410-878-1085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2024-10-28 |