| NPI | 1700771862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAILEY KOCHIS-EDGERTON CEO 689-275-4964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 251B00000X Case Management | |
| 261QC1500X Clinic/Center Community Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QP2300X Clinic/Center Primary Care | |
| 261QR0401X Clinic/Center Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-06-10 |