| NPI | 1164485074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BECKY RAZAIRE Admin Director 863-899-9538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2024-10-16 |