| NPI | 1033262860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN M LEWIS Billing Manager 339-883-2166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MA 4463) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2024-10-16 |