| NPI | 1245037019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD R SHIREY Program Director 619-669-3295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2025-02-27 |
| Last Update Date | 2025-03-05 |