| NPI | 1356193544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY RENNA THOMAS Billing Manager 410-616-9552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2024-04-02 |