| NPI | 1346923992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERIAH WALTERS Credentialing Agent 740-856-1084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2023-08-10 |