| NPI | 1962950881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA BUSCH Dir Of Contracts And Credentialing 445-206-3028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: DE 1062) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2024-10-28 |