NPI | 1841780475 |
---|---|
Entity Type | Organization |
Authorized Contact | DEGOLIA M JOHNSON Owner 208-208-7613 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2018-05-18 |
Last Update Date | 2021-11-06 |