| NPI | 1801610241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERONE BRACEY COO 346-529-7822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-11-12 |