| NPI | 1114721453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY ROBINSON Owner 318-603-2972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2025-04-04 |
| Last Update Date | 2025-08-21 |