| NPI | 1174324115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVORY GLORIA MARVIN CEO 443-675-2036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-03-24 |