| NPI | 1265243166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY FANSLER Owner 863-473-2083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-01-20 |