| NPI | 1114332442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET LEIKER Executive Director 866-374-1220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: OK 10000000) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 956) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-06-25 |