| NPI | 1003166307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JON JACKOBOICE CEO 239-591-6240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-09-13 |