| NPI | 1134704307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER PENROD Admin 305-900-4715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2021-03-10 |