| NPI | 1427608660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY NANCY SOTO Billing Manager 888-511-0607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |