| NPI | 1003598558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALI PETERSON Executive Director 877-835-1545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2023-08-03 |