| NPI | 1265068233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE E LOGAN Owner 808-437-7447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2021-10-06 |