| NPI | 1053015438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED TURNER Billing Manager 772-812-9652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2024-04-18 |