| NPI | 1992312896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA SANDOVAL Owner 419-290-1495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2024-08-13 |