| NPI | 1346983988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY D PHILLIPS Ar Director 618-937-6483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2022-04-20 |