| NPI | 1144019480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANTAYLIENIERE MILLER Executive Director 800-551-1174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2025-05-03 |
| Last Update Date | 2025-05-03 |