| NPI | 1295107381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH FITZEMEYER Owner/CEO 754-216-3338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2019-01-08 |