| NPI | 1780811372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA K BUSCH Payer Contract Specialist 445-206-3028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| 261QM0801X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2022-02-19 |