| NPI | 1043107717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEI FERGUSON Owner 260-446-7613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-06-23 |