| NPI | 1215636956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRILL VESSELOV President 561-305-0461 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2023-12-18 |