| NPI | 1386771020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH J PROVENZA Executive Director 802-442-5491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2008-03-14 |