| NPI | 1013476431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN T DEERING CEO/Owner 772-519-0544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2024-10-23 |