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 |