| NPI | 1053528901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J. VALENTINE Executive Director 662-324-2230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: MS FS87-DADA-OP-01) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2013-07-23 |