| NPI | 1942663117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TUCKER President 844-239-3737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 10627782#MVM73) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2016-04-04 |