| NPI | 1215511720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KACY MARIE EAST Office Manager 251-800-1166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2021-05-11 |