| NPI | 1174289961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT TYLER BRADY Owner/Program Sponsor 864-616-5031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2023-03-31 |