| NPI | 1386366706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUPERT MCCORMAC Md 800-805-6989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM2800X Clinic/Center Methadone | |
| 261QP2300X Clinic/Center Primary Care | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2022-09-13 |