| NPI | 1841049129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA KAMAU Investor 984-326-8722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| 261QU0200X Clinic/Center, Urgent Care | |
| 332100000X Department of Veterans Affairs (VA) Pharmacy | |
| 332S00000X Hearing Aid Equipment | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2024-05-17 |