| NPI | 1194211052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAYTHE MOYER Billing Director 410-276-1773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2018-07-03 |