| NPI | 1366431686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN MARIE TAYLOR Managed Care Supervisor 888-924-3786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0801X |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2023-03-16 |