| NPI | 1023775830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMELA J FERGUSON Owner/ Nurse Practitioner 443-802-5130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2023-03-06 |