| NPI | 1932325883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA MARIE KELLOGG Program Director 954-587-1008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MT2003) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |