| NPI | 1780562884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA JANICAK Revenue Cycle Manager 877-553-9440 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-08-26 |
| Last Update Date | 2025-08-26 |