| NPI | 1871144725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTAL LONG Credentialing Manager 888-985-5455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 251S00000X |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2021-08-20 |