| NPI | 1104467158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL FRANK BLAZIK Consultant 419-366-3974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2021-06-14 |