| NPI | 1730945593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLENE RAE MANNING Owner 505-215-9639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2025-03-06 |