| NPI | 1083384879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA RENEE STAMP Billing Director 270-317-0169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2021-10-21 |