| NPI | 1972992659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY DALE KOERSELMAN Owner 712-737-9444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 007682) |
| Enumeration Date | 2015-01-18 |
| Last Update Date | 2016-04-29 |