| NPI | 1194069708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH B RIKER Executive Director 2033-365-2258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: CT 0442) |
| Additional Taxonomies | 261QM0801X (Licence: CT 0442) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2013-01-02 |