| NPI | 1073116208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAE BOWMAN Founder/Director 508-446-5829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2020-11-19 |