| NPI | 1255682027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS GONZALEZ Owner/Manager 772-633-1097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: VA 348) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |