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 |