| NPI | 1194456962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMERON VANCE Administrator 270-320-2605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2023-01-10 |