| NPI | 1891279410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA SHANK CEO 386-597-2861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 253J00000X Foster Care Agency | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2019-05-31 |