| NPI | 1073912606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MARINO Chairman 772-800-3990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: FL HCC10590) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5646277703302) |
| 101YM0800X Counselor, Mental Health (Licence: FL 5646277703302) | |
| 101YP2500X Counselor, Professional (Licence: FL 5646277703302) | |
| 208D00000X General Practice | |
| 208D00000X General Practice | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 5646277703302) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2017-11-01 |