| NPI | 1285005629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORMA JEAN CARROW CEO 863-402-1442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 2801) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2022-07-21 |