| NPI | 1013695113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI FIELDS Credentialing Consultant 443-567-6120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X |
| 261QR0800X Clinic/Center, Recovery Care | |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2023-08-01 |