| NPI | 1679508022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAH A BALLANTYNE Manager, Provider Enrollment 641-428-3086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 273R00000X Psychiatric Unit (Licence: IA 970112H) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-05-27 |