| NPI | 1114168564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN SUMROK Owner 731-431-3010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: TN 4072) |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2009-03-16 |