| NPI | 1033453170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYCE E HUDNALL Director 817-606-9580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: TX 67601) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: TX 67601) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |