Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Community/Behavioral Health |
251S00000X |
| NPI Number | 1295158145 |
||||
| LBN Legal business name | MOMENTUM INSTITUTE OF THERAPEUTIC AND COMMUNAL SERVICES LLC | ||||
| Authorized official | JOSEPH JOHNSON - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 01/29/2014 | ||||
| Last updated | 01/29/2014 - About 12 years ago | ||||
| Identifiers |
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