| NPI | 1316156045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIA FORTHUM Executive Director 580-623-7283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |