| NPI | 1225820939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS BRADY STARK Owner 812-801-1352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-05-19 |
| Last Update Date | 2025-05-19 |