| NPI | 1720842875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS EGBUNIKE Regional Director 308-216-8545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2024-02-09 |
| Last Update Date | 2024-02-09 |