| NPI | 1982484929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVETTE HENNESSEY Director Of Revenue Integrity 712-870-3445 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |