| NPI | 1295361962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI POWELL Billing Manager 443-701-9295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2020-03-13 |