| NPI | 1013633882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRZO KHASIMOV President 608-520-7142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2022-10-14 |