| NPI | 1114099421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CONOVER Chief Revenue Officer 660-665-1962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: A-7895-0003-A) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2022-06-10 |