| NPI | 1871192427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLEE KATHRYN VANCE Director Of Utilization Management 386-668-4774 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-10-23 |