| NPI | 1356818637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FERNANDO M LOPEZ-IVERN Owner / M.D 866-731-6777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2018-10-25 |