| NPI | 1164817144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER HALL Director Of Billing 772-261-3422 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: PA 357243) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: PA 357243) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2019-12-27 |