| NPI | 1205349362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT GRANT GOODWIN Practice Manager 937-530-0291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 207LA0401X Anesthesiology Addiction Medicine | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM2500X Clinic/Center Medical Specialty | |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2018-03-17 |