| NPI | 1942066329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVERON KRISTOPHER DAUGHTREY Statutory Agent 951-488-5337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-02-23 |