| NPI | 1184005803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAYLOR E GAINES Chief Executive Officer 855-454-3376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: FL 0237AD383201) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2015-06-18 |