| NPI | 1447602552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDEN COLUCCIO CFO 877-636-9322 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: PA 467132) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2019-01-25 |