| NPI | 1700066073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN EDWARD DARRISAW CEO 772-528-6628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 688140896) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2017-03-17 |