| NPI | 1265764682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN P GRIFFITH Program Administrator 937-717-5843 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 12401) |
| 251B00000X Case Management (Licence: OH 12401) | |
| 302R00000X Health Maintenance Organization (Licence: OK 12401) | |
| 302R00000X Health Maintenance Organization (Licence: OH 12401) | |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2020-12-09 |