| NPI | 1447712534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MELLO President 800-762-6717 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QR0400X Clinic/Center Rehabilitation | |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2020-02-14 |