| NPI | 1194188656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS THAMES CEO 772-361-6778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 5601) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2022-07-21 |