| NPI | 1871150656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TENNILLE HARRIS Human Resource Director 877-290-0201 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |