| NPI | 1699231738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW CORSO Executive Director 866-382-9917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2019-02-13 |