| NPI | 1134755960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI POWELL Billing Manager 301-703-8767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QR0800X Clinic/Center, Recovery Care |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2020-03-12 |