| NPI | 1770047060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADFORD WAYNE PHILLIPS Executive Management 681-238-6412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2024-07-24 |