| NPI | 1275363244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID PRIDGEN Co Owner 443-506-0709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-12-03 |