NPI | 1316403405 |
---|---|
Entity Type | Organization |
Authorized Contact | CREDENTIALING STAFF President/CEO 800-805-6989 |
Organization Subpart ? | No |
Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
261QM1300X Clinic/Center, Multi-Specialty | |
Enumeration Date | 2019-02-14 |
Last Update Date | 2021-07-01 |