| NPI | 1740175496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESHRA VINES-LEAK Health Care Administrator 419-410-9438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 1041C0700X Social Worker, Clinical | |
| 251B00000X Case Management | |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2025-06-12 |
| Last Update Date | 2025-06-12 |