| NPI | 1902323223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID TATRO CEO 419-502-2822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2024-05-09 |