| NPI | 1023882511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMED BURRHAN AFMEGED Program Sponsor 380-895-4698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2025-06-30 |