| NPI | 1275073488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE J MAVROOKAS Owner 754-200-4373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 0601) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 0618128360001) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2025-04-16 |