| NPI | 1043784184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL GRANT Program Director 443-435-4771 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-01-11 |