| NPI | 1700390101 |
|---|---|
| Doing Business As | COVERT ACTION |
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER M COVERT Program Sponsor 515-778-6608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: IA 1404) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2017-11-21 |