| NPI | 1881089332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN MEYERMANN Program Director 563-593-8257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM LPN-21303) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2015-04-01 |