| NPI | 1366210239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA CHEADLE Owner 740-207-1168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2023-12-19 |