| NPI | 1093404063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS MACOMBER Billing 617-833-8144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2025-09-30 |