| NPI | 1114603594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY SHIRELLE GAMBLE COBB Executive Director 718-230-1379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2023-06-22 |