| NPI | 1154087237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISMAIL K AHMAD CEO 443-613-0246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2021-11-12 |