| NPI | 1730956293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY RANDOLPH Owner 631-546-8849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 177F00000X Lodging |
| Enumeration Date | 2023-12-05 |
| Last Update Date | 2025-12-11 |