| NPI | 1083710693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY N. LOLLMAN Director 782-266-0202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: KS 595) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-22 |