| NPI | 1144797143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANDON WHITE Owner 410-237-6599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2018-10-28 |
| Last Update Date | 2018-10-28 |