| NPI | 1831590421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN RENEE JOHNSON Asst Dir Of Patient Accounting 872-588-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TC0700X Psychologist, Clinical | |
| 122300000X Dentist | |
| 133N00000X Nutritionist | |
| 152W00000X Optometrist | |
| 164W00000X Licensed Practical Nurse | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2021-07-01 |