| NPI | 1114547726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN REIDY Office Admin 800-819-7570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2022-05-11 |