| NPI | 1124597182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE E WIEDENMANNOTT Medicare Coordinator 440-989-5238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2023-06-27 |