| NPI | 1386376754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRA MAZIQUE-GILBERT Administrative Assistant 870-316-0234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2022-06-25 |
| Last Update Date | 2022-06-25 |