| 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 |