| NPI | 1164143020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MASON MATTHEW TERRY Office Manager 909-379-9237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2022-09-20 |