| NPI | 1245981760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANDALEE JACKSON Credentialing Manager 561-562-6271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2022-03-22 |