| NPI | 1427664366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE TELMOSSE Billing/Credentialing Specialist 546-843-9959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2020-09-24 |