| NPI | 1740953330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN COSIMI CEO 386-236-1811 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2022-02-21 |