| NPI | 1700574142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC SHAPIRO CFO 667-239-3293 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2023-04-25 |