| NPI | 1245198209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKELLE MOSES Owner 667-225-9027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2026-01-09 |
| Last Update Date | 2026-01-09 |