| NPI | 1346772019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BALCOM CFO 516-733-7032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: NY 12049) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2017-03-31 |