| NPI | 1790192060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EGHOSA OLAYINKA AIDEYAN President 346-494-0207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251B00000X Case Management |
| 261QD1600X Clinic/Center Developmental Disabilities | |
| 261QH0100X Clinic/Center Health Service | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2022-06-27 |