| NPI | 1790484657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANKAR EZOM Marketing Manager 701-730-8269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2023-03-01 |