| NPI | 1932656097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY TAYLOR Manager 386-212-2061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse |
| 251E00000X Home Health | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |