| NPI | 1063109114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KETTY M NGONA CEO 443-465-9958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-04-19 |