| NPI | 1205388527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT NIZNIK CEO 855-370-4462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2021-11-03 |