| NPI | 1730502725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY HYDASH President & CEO 877-960-3426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2022-10-27 |