| NPI | 1073386355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIME BOGOVICH Operations 518-698-3757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-07-24 |