NPI | 1205424405 |
---|---|
Former Legal Business Name | MAGENTA HAZE PR |
Entity Type | Organization |
Authorized Contact | CHARDE PETRUS Director 661-797-4018 |
Organization Subpart ? | Yes |
Primary Taxonomy | 251E00000X Home Health |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
167G00000X Licensed Psychiatric Technician | |
Enumeration Date | 2021-01-05 |
Last Update Date | 2021-01-05 |