| NPI | 1134807357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN M TAYLOR Revenue Credentialing Specialist 186-512-1803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2023-07-07 |