| NPI | 1154073773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA PEARSON Professional Services Director 765-242-0955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2022-01-25 |