| NPI | 1063167906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN A COSIMI CEO 386-236-1811 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-02-18 |