| NPI | 1356103154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLIE JO BRADY Director 150-180-2607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2024-01-26 |