| NPI | 1215563986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI POWELL Manager 443-701-9295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 261QR0401X Clinic/Center Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2020-03-13 |