| NPI | 1962149864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN PORTEUS CEO 916-737-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2022-05-13 |
| Last Update Date | 2022-06-07 |