| NPI | 1780950683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILA MAUREEN DEBOSE Owner 479-719-7051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: AR 2158-C) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2015-04-27 |