NPI | 1720623770 |
---|---|
Entity Type | Organization |
Authorized Contact | KIMBERLY MOTOSICKY Credentialing Supervisor 866-287-2036 |
Organization Subpart ? | Yes |
Primary Taxonomy | 251S00000X Community/Behavioral Health |
Enumeration Date | 2019-11-14 |
Last Update Date | 2019-11-14 |