| NPI | 1336636216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA OVERSMITH Billing Manager 667-600-2249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2018-04-17 |