| NPI | 1194368373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM VINCENT Contravting 541-516-4087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2019-12-26 |