| NPI | 1053972182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA SPADAFORA Administrator 352-678-5550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 251S00000X | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2021-10-15 |