| NPI | 1972384469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON NATHAN FORD Manager 346-842-0424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2026-09-15 |