| NPI | 1780966804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL SHOVLAIN Administrator 563-355-0055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 00946) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |