| NPI | 1093103251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JARVIS Owner 857-225-1998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 5047165841301) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL 5047165841301) | |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2016-05-11 |