| NPI | 1356191837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANNER GRIMSLEY Owner 701-317-8855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2024-10-21 |