| NPI | 1356056121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENNY ORTIZ Billing 617-733-4233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2025-11-11 |