| NPI | 1881072445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODY LYNN ANGEL-TREJO Owner 308-236-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NE 4168) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2021-02-09 |