| NPI | 1790192060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EGHOSA OLAYINKA AIDEYAN President 346-494-0207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 251B00000X Case Management | |
| 261QH0100X Clinic/Center, Health Services | |
| 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 |