| NPI | 1003537390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY HANSON CEO 877-989-9198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2022-09-06 |