| NPI | 1245554419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIVAN WILSON CEO 505-260-9917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2021-07-06 |