| NPI | 1275017329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Licensing And Credentialing Special 410-807-8471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2021-04-22 |