| NPI | 1043849896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA BLOCKER CFO 864-800-3223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2021-06-03 |