| NPI | 1235764200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA LYLE Billing Specialist 667-212-3626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-03-10 |