| NPI | 1124735717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Administrator 443-548-3733 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2023-06-06 |