| NPI | 1215648738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIVELLA VONNER CEO 419-410-4933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251S00000X | |
| Enumeration Date | 2022-12-06 |
| Last Update Date | 2022-12-06 |