| NPI | 1396287264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE KOHAN Owner 732-910-1427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-11-09 |