| NPI | 1396101200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DICKY WALIA Interim CEO 984-200-2780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2026-07-23 |