| NPI | 1376157032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDALL MCCULLAR Credentialing Specialist 225-900-8940 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |