| NPI | 1225779234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYIA GODLOCK Owner 410-262-6030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-04-05 |