| NPI | 1861826158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NENKERWON TROH Community Support Provider 857-919-9535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MA S20630711) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2013-08-22 |