| NPI | 1154799906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA TUCKER CEO 772-219-1355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 1943AD548101) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2015-09-11 |