| NPI | 1770324758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR STANLEY JORDAN Chief Financial Officer 508-340-6228 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2024-09-10 |