| NPI | 1154019016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY BLAIR ELDER Revenue Cycle Administrator 737-247-1223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2023-05-02 |