| NPI | 1952130817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE TATE Owner 330-936-9633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-07-30 |
| Last Update Date | 2024-07-30 |