| NPI | 1376309302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J HENDRICKS Owner 203-813-4892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2025-09-23 |